A STUDY ON THE MEDICAL CARE COST FOR PEOPLE WITH HIV / AIDS IN JAPAN

目的：本研究根据CD 4细胞计数将HIV感染者（PWH）和AIDS患者（PWA）进行分类，并分别分析每类患者中血友病患者和非血友病患者的门诊和住院治疗费用。临床分期为AC-1（n=28），CD 4细胞计数> 500 ; AC-2（n=45），CD 4细胞计数200-500 ; AC-3（n=34），CD 4细胞计数小于200 ;和AIDS患者（n=46）。威尔斯亲王医院及威尔斯亲王医院管理局的门诊及住院护理费用，是根据每月保险付款单的收据而进行调查。逐项计算每位患者的药物费用，并通过将费用除以门诊或住院治疗的实际天数计算4个疾病阶段组的平均每日医疗护理费用。在使用抗HIV药物的患者中，计算AZT和ddI的费用，并确定抗HIV药物占医疗总费用的百分比。AC-2组和AC-3组接受抗HIV药物治疗的非血友病患者的每月医疗费用分别高出2.5倍和3.5倍，抗HIV药物费用占总费用的60%以上。血友病患者中也观察到类似的趋势，抗HIV药物占医疗费用的40%-60%，不包括凝血因子产品的家庭护理费用。抗HIV药物治疗HIV / AIDS的终生费用估计为13，440，000日元。结论：随着疾病的进展，门诊治疗费用增加，尤其是抗HIV药物的使用。

Objective : In this study, we categorized patients with HIV (PWH) and AIDS (PWA) according to the CD4 cell count, and separately analyzed the costs of outpatient and inpatient care for the hemophiliac and non-hemophiliac patients in each category.Materials ＆ Methods : HIV infection was classified into 4 stages reflecting severity of disease. The stages were AC-1 (n=28), CD4 cell count ≧ 500 ; AC-2 (n=45), CD4 count 200-500 ; AC-3 (n=34), CD4 count less than 200 ; and AIDS patients (n=46). The costs of outpatient and inpatient care for PWH and PWA were investigated on the basis of receipts for monthly statements of insurance payments. The costs of medication were calculated item by item for each patient, and the mean cost of medical care par day was calculated for the 4 disease stage groups by dividing the costs by the actual number of days of outpatient or inpatient care. In the patients receiving anit-HIV drugs, we calculated the costs of AZT and ddI, and determined the percentage of the total cost of medical care occupied by anti-HIV drugs.Results : The monthly cost of medical care for the non-hemophiliac patients receiving anti-HIV drugs was 2.5 times and 3.5 times higher in the AC-2 and AC-3 groups, respectively, than that in the AC-1 group of patients not receiving anti-HIV drugs.The cost of anti-HIV drugs accounted for more than 60% of the total cost. A similar tendency was also observed in the hemophiliac patients, and anti-HIV drugs accounted for 40%-60% of the cost of medical care excluding the home-care costs of coagulation factor products. The life-time cost for HIV / AIDS treatment with anti-HIV drugs was estimated to be 13,440,000 yen.Conclusion : The cost of outpatient care increased a the disease progressed ; especially, in Terms of the use of anti-HIV drugs.