The Silver Tsunami: Projecting multimorbidity, polypharmacy,and healthcare costs for those aging with HIV in the US

银色海啸：预测美国艾滋病毒感染者的多重发病率、多药治疗和医疗保健费用

• 批准号: 9137799
• 负责人: Keri Nicole Althoff
• 金额: $ 54.87万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9137799
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Achievement; Acquired Immunodeficiency Syndrome; Adult; Affect; Age; Age Distribution; Aged, 80 and over; Aging; American; Awareness; Baby Booms; Budgets; Cardiovascular system; Caring; Characteristics; Chronic Kidney Failure; Clinical Management; Collaborations; Comorbidity; Cost Savings; Cost of Illness; Data; Databases; Disease; Elderly; End stage renal failure; Environment; Epidemiology; Funding; General Population; Geography; Goals; Guidelines; HIV; HIV Infections; Health Care Costs; Health Services; Health Services Accessibility; Health system; Health system plans; Healthcare; Healthcare Systems; Individual; Insulin Resistance; Intervention; Investigation; Knowledge; Life; Life Expectancy; Malignant Neoplasms; Mentored Research Scientist Development Award; Metabolic; Methods; Modeling; Myocardial Infarction; Neurologic; Persons; Pharmaceutical Preparations; Policies; Polypharmacy; Population; Principal Investigator; Productivity; Public Health; Race; Research; Research Design; Research Priority; Resource Allocation; Risk; Savings; Seasons; Silver; Tsunami; United States; United States National Institutes of Health; age related; co-infection; cohort; cost; cost effectiveness; effective therapy; experience; health care service utilization; human old age (65+); models and simulation; prevent; programs; public health relevance; sex; transmission process

 DESCRIPTION (provided by applicant): Due to effective treatment, persons living with HIV and accessing care (PLWHC) in the United States (US) now have a life expectancy approaching the general population. In the general population, the population bubble caused by the post-WWII Baby Boom has been referred to as the "Silver Tsunami." The goal of this project is to fill a vital gap for a more detailed, data-based projection of the imminent PLWHC Silver Tsunami to better inform allocation of resources in governmental and private healthcare systems and to identify targets for savings. Taking into account factors that affect the age distribution of PLWHC in the US, we will use simulation models to project the age distribution through 2030 to answer the question: "What does the projected age distribution of PLWHC in the US look like?" To be useful, data need to be disaggregated by important demographic (sex and race) and geographical characteristics. HIV infection has been shown to increase the risk of insulin resistance, chronic kidney disease, myocardial infarction, end-stage renal disease, and cancer. Incorporating multimorbidity and polypharmacy into the projected age distribution will answer: "What is the projected burden of multimorbidity and polypharmacy in adults aging with HIV?" Information derived by a careful, data-based analysis that includes the burden of multimorbidity and polypharmacy in PLWHC will have many uses. We propose to focus on the important issue of healthcare costs as it is likely that costs will be compounded in adults aging with HIV as compared to those without HIV. By investigating the question "How much will it cost to care for adults aging with HIV?" health systems and state and federal budgets can begin to prepare for both HIV-related and non-HIV-related costs and identify targets for potential cost savings. We have assembled a world-class collaboration that combines high-quality longitudinal data, epidemiological expertise, the scientific leaders of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), and the leaders in modeling of HIV disease and healthcare costs from the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) team to achieve the following aims: AIM 1: To fill the gap in knowledge by projecting age-specific proportions of PLWHC in the US through 2030, with estimates tailored to important demographic and geographic sub-groups. AIM 2: To project the burden of multimorbidity and polypharmacy among PLWHC in the US through 2030. AIM 3: To project the annual costs of non-HIV-related healthcare for PLWHC in the US through 2030. The proposed aims align well with the research priorities of the 2016 Trans-NIH Plan for HIV-Related Research and the NIH HIV/AIDS Research Priorities and Guidelines for Determining AIDS Funding. Findings will provide key HIV epidemiologic and health services data that are necessary for guiding research priorities, increasing awareness of multimorbidity and polypharmacy in clinical management, and informing health systems resource allocations.

 描述（由申请人提供）：由于有效的治疗，美国（US）的艾滋病毒感染者和获得护理的人（PLWHC）现在的预期寿命接近普通人群。在一般人群中，二战后婴儿潮造成的人口泡沫被称为“银海啸”。“该项目的目标是填补一个重要的空白，对即将到来的艾滋病毒/艾滋病银海啸进行更详细的、基于数据的预测，以更好地为政府和私人医疗保健系统的资源分配提供信息，并确定储蓄目标。考虑到影响美国艾滋病病毒携带者和妇女感染者年龄分布的因素，我们将使用模拟模型预测到2030年的年龄分布，以回答以下问题：“美国艾滋病病毒携带者和妇女感染者的预计年龄分布是什么样的？“为了有用，数据需要按重要的人口（性别和种族）和地理特征分列。艾滋病毒感染已被证明会增加胰岛素抵抗、慢性肾病、心肌梗死、终末期肾病和癌症的风险。将多药治疗和多种药物治疗纳入预测的年龄分布将回答：“在患有艾滋病毒的老年人中，多药治疗和多种药物治疗的预测负担是什么？“通过仔细的、基于数据的分析得出的信息，包括艾滋病毒/艾滋病感染者的多重死亡和多种药物治疗的负担，将有许多用途。我们建议重点关注医疗保健费用这一重要问题，因为与未感染艾滋病毒的人相比，感染艾滋病毒的成年人的费用可能会增加。通过调查“照顾成年艾滋病毒感染者要花多少钱？“卫生系统以及州和联邦预算可以开始为艾滋病毒相关和非艾滋病毒相关的费用做准备，并确定潜在的成本节约目标。 我们已经建立了一个世界级的合作，结合了高质量的纵向数据，流行病学专业知识，北美艾滋病队列研究和设计合作的科学领导者，（NA-ACCORD）和预防艾滋病并发症的成本效益（CEPAC）团队的艾滋病毒疾病和医疗保健成本建模领导者，以实现以下目标：目标1：通过预测到2030年美国艾滋病毒/艾滋病感染者的特定年龄比例，填补知识上的差距，并根据重要的人口和地理亚组进行估计。目的2：预测到2030年美国PLWHC中多药治疗和多种药物治疗的负担。目标3：预测到2030年美国PLWHC的非艾滋病毒相关医疗保健的年度成本。 拟议的目标与2016年跨NIH艾滋病毒相关研究计划和NIH艾滋病毒/艾滋病研究优先事项和确定艾滋病资金的指导方针的研究优先事项保持一致。研究结果将提供关键的艾滋病毒流行病学和卫生服务数据，这些数据对于指导研究重点，提高临床管理中对多药和多药治疗的认识以及告知卫生系统资源分配是必要的。