农村地区艾滋病抗病毒治疗的直接成本分析

目的:估算我国综合性艾滋病研究项目(China integrated program for research on AIDS,China,CIPRA)临床治疗的直接成本,为在我国农村地区推行艾滋病(HIV/AIDS)高效抗逆转录病毒治疗(Highlv Active Anti-retroviral therapy,HAART)提供卫生经济学方面的参考依据.方法:收集治疗的成本资料.根据当地的医疗服务价格水平,估算包括抗病毒药品费用、随访检查费用及不良事件(adverse event,AE)处理费用的直接成本.结果:治疗1年期间.100例患者因不良事件平均每人住院为3.5天,每人门诊治疗为3.6次,平均每日住院费用和每次门诊费用分别为186.8元和43.0元.每人治疗总费用为26 521.3元,其中抗病毒药品费用占67.0%.有效性监测费用占26.4%,安全性监测费用占3.5%,不良事件处理费用占3.0%,处理不良事件的费用约占当地农民人年均收入的30.0%.结论:按本方案在中国中西部农村地区以县级医疗机构为基点开展HAART治疗.每人每年的直接成本约为26 500.0元,安全性监测费用占总费用比例较小,是为保证HAART治疗安全必须优先投入的部分.不良事件处理费用成为当地HIV/AIDS患者的重要经济负担.需要相应的补偿机制予以分担.     

河南省农村地区HIV/AIDS卫生服务利用现状调查

[目的]利用2004年和2009年对河南省农村地区HIV/AIDS的基线调查数据,分析艾滋病防治政策实施后卫生服务利用的改善情况,为政策改进提供感染者数据支持。[方法]通过问卷调查收集HIV感染者、AIDS患者以及对照人群对各级医疗机构的门诊和住院服务利用情况。[结果]调查前三个月内,AIDS患者、HIV感染者和对照组门诊平均就诊次数分别为33.55次、24.55次和10.28次,平均住院次数分别为0.43次、0.37次和0.26次,前两组均高于后者;HIV/AIDS对各级医疗机构的满意度均高于健康对照者（t=3.046,P〈0.05）。[结论]与2004年调查结果相比,HIV/AIDS对各级医疗卫生机构利用率呈明显上升趋势,且集中在村卫生室和乡镇卫生院就诊和住院。建议加强基层医疗卫生机构卫生服务能力建设,以保证农村为基础的艾滋病医疗救治体系可持续发展。     

艾滋病患者和HIV感染者的卫生服务利用现状研究

目的:掌握艾滋病(AIDS)患者和人类免疫缺陷病毒(HIV)感染者的门诊量和住院量以及在各级医疗机构的分布,为开展 AIDS 医疗救治提供基础资料一方法:采用访谈法调查 AIDS 患者和 HIV 感染者的门诊量和住院量以及他们在各级医疗机构的分布,进行非 HIV 感染者和 AIDS 患者对照,分析 AIDS 患者和 HIV 感染者的卫生服务利用特征。结果:AIDS 患者、HIV 感染者和健康时照的3个月的就诊次数分别为23.672次、13.549次和2.724次,AIDS 患者和 HIV 感染者高于健康对照(X~2=925.526,P<0.000);AIDS 患者、HIV 感染者和健康对照的3个月住院次数分别为0.593 095次、0.176119次和0.078027次,AIDS 患者和 HIV 感染者高于健康对照(X~2=43.716,P<0.000);AIDS患者、HIV感染者和健康对照在村卫生室就诊的比例分别为80.83%、82-31%和65.72%(X~2=786.425,P<0.000),在乡镇卫生院住院的比例分别是68.19%、84.75%和43.68%(X~2=38.720,P<0.000)。结论:AIDS 患者和 HIV 感染者的门诊和住院服务利用率均高于对照人群;门诊病人集中在村级医疗机构,住院病人集中在乡镇卫生院。病人分布与对照人群存在较大差异。     

乌鲁木齐市维吾尔族HIV感染者卫生服务需要、利用和医疗费用的调查

目的了解乌鲁木齐市维吾尔族艾滋病病毒(human immunodeficiency virus,HIV)感染者的卫生服务需要、利用和医疗费用,为制定维吾尔族HIV感染者相关政策和措施提供依据。方法采用自行设计的问卷对77例维吾尔族HIV感染者进行单独面访,同时收集相关的实验室结果和诊疗记录,所获资料采用Excel 2003录入和分析。结果乌鲁木齐市维吾尔族HIV感染者两周患病率为76.6%,慢性病患病率为46.8%;两周就诊率为75.3%,两周患者未就诊率为39.0%,58.3%因经济困难未就诊;住院率为31.2%,应住院而未住院比例为31.4%,因经济困难未住院的占72.7%;次均门诊医疗费用为121元,次均住院医疗费用为6 874元。结论乌鲁木齐市维吾尔族HIV感染者的卫生服务需要和利用量大,经济负担重,卫生部门应针对其卫生服务特点及早制定相应对策,建立医疗救助机制满足其卫生服务需求。     

乌鲁木齐市维吾尔族HIV感染者卫生服务需要、利用和医疗费用的调查

目的了解乌鲁木齐市维吾尔族艾滋病病毒(human immunodeficiency virus,HIV)感染者的卫生服务需要、利用和医疗费用,为制定维吾尔族HIV感染者相关政策和措施提供依据。方法采用自行设计的问卷对77例维吾尔族HIV感染者进行单独面访,同时收集相关的实验室结果和诊疗记录,所获资料采用Excel 2003录入和分析。结果乌鲁木齐市维吾尔族HIV感染者两周患病率为76.6%,慢性病患病率为46.8%;两周就诊率为75.3%,两周患者未就诊率为39.0%,58.3%因经济困难未就诊;住院率为31.2%,应住院而未住院比例为31.4%,因经济困难未住院的占72.7%;次均门诊医疗费用为121元,次均住院医疗费用为6 874元。结论乌鲁木齐市维吾尔族HIV感染者的卫生服务需要和利用量大,经济负担重,卫生部门应针对其卫生服务特点及早制定相应对策,建立医疗救助机制满足其卫生服务需求。     

河南省艾滋病高发区村卫生室建设现状分析

农村卫生室是三级医疗保健网的最基层单位，农村的各项卫生工作任务，都需要村卫生室具体实施落实，从而使医疗、预防保健和健康教育延伸到每一个农民家庭，为基层提供最方便而费用又低廉的医疗预防保健服务。河南省农村HIV／AIDS者多为既往有偿供血人员经采供血感染，2003年前后进入发病高峰，97．72％的HIV感染者和96．82％的艾滋病（AIDS）患者分布在农村。当地政府为加强艾滋病防治工作，对HIV感染者在20人以上的村加强了村卫生室建设，装备了部分设备，进行了人员培训。为了解目前艾滋病高发区村卫生室的建设状况和卫生服务状况，为制定艾滋病防治政策提供基础数据，我们于2005年对高发区村卫生室建设情况进行了调查，结果报告如下。     

南京市艾滋病抗病毒治疗患者疾病负担及其影响因素分析

目的 分析南京市艾滋病抗病毒治疗患者因艾滋病造成的经济负担及其影响因素。方法 按疾病名称将接受抗病毒治疗患者分为HIV感染者和AIDS患者(HIV/AIDS), 收集两者过去一年因艾滋病直接医疗费用、直接非医疗费用和间接经济损失。对总费用和直接医疗费用进行单因素和多因素分析, 探寻其影响因素。结果 133例HIV感染者年直接医疗费用和总费用中位数分别为1 200元和1 972元, 145例AIDS患者年直接医疗费用和总费用中位数分别为1 060元和2 826元。HIV/AIDS直接医疗费用和总费用差异无统计学意义。单因素分析结果显示, 样本来源不同, 总费用不同。多因素分析结果表明, 发病时间与CD₄⁺T淋巴细胞计数水平、直接医疗费用呈负相关, 经同性性接触感染者医疗费用低于异性性接触者, 样本来源为其他就诊的检测者直接医疗费用高于自愿检测咨询者。结论 应进一步扩大检测和治疗覆盖面, 以期尽早发现感染者, 尽快给予抗病毒治疗, 维持患者免疫功能, 进而降低HIV/AIDS医疗费用。     

信阳市艾滋病自愿咨询检测结果分析

目的通过艾滋病自愿咨询检测（VCT）及早发现、及时治疗艾滋病（AIDS）病人，并为求询者提供干预措施，降低感染危险和预防艾滋病病毒（HIV）的传播。方法设置艾滋病咨询室，提供规范的VCT服务。收集信阳市2006年48个VCT点（门诊）前来求询人员的“咨询个案，登记表”和“VCT咨询检测流动日报表”。结果1年来，共为8490名求询者提供VCT服务，发现HIV／AIDS患者117例，阳性率为1．38％。结论开展VCT服务可以迅速吸引具有高危行为的人接受咨询检测，高效地发现阳性感染者。     

社会组织参与艾滋病防治基金对我国艾滋病防治促进效果评估

目的 评估社会组织参与艾滋病防治基金（China AIDS Fund for Non-governmental Organizations,CAFNGO）对我国艾滋病防治工作的促进作用，总结经验与教训，并提出建议。方法 围绕2016—2020年CAFNGO重点人群干预及人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者和艾滋病患者随访关怀两个核心领域，系统收集和分析投入、产出和效果，并与国家和省级相关指标进行对比分析。结果2016—2020年CAFNGO累计投入资金2.79亿元人民币，其中93.19%来自中央财政经费，平均每年支持800个社会组织参与艾滋病防治工作；累计为179万重点人群提供HIV抗体检测服务，占同期全国重点人群HIV抗体检测人数的17.25%，新发现HIV感染者46 118例，占同期全国新发现HIV感染者的6.67%，其中，新发现男男同性性行为人群（men who have sex with men,MSM） HIV感染者45 045例，占同期全国新发现经同性性途径感染者的26.58%；累计为31.53万例HIV感染者和艾滋病患...     

我国慢性病直接经济负担研究

目的:通过对1993年和2004年《中国卫生统计年鉴》和第一次及第三次国家卫生服务调查相关数据的分析,测算5类慢性疾病的直接医疗费用。方法:直接医疗费用由出院人数、出院患者平均住院医疗费用、门诊人次数和门诊病人次均医疗费用求得。结果:2003年5类慢性疾病的直接医疗费用为1209.42亿元,其中,住院医疗费用588.37亿元,门诊医疗费用为621.05亿元:5类慢性疾病的直接医疗费用构成了国家医疗总费用的重要组成部分(占21.05%),其中,各病种(类)的费用负担在门诊和住院中表现不一,并且在城市主要以住院费用为主,在农村则以门诊费用为主;自1993年以来,其年平均增长速度为14.37%,超过了同期国内生产总值(GDP)、卫生总费用和医疗总费用的增长速度,其中,门诊病人次均医疗费用和出院者平均住院医疗费用的增长速度大大超过了同期的门诊人次数和出院人次数的增长速度,提示我国医疗行业存在垄断现象。     

Hospital cost for patients with HIV infection in a university hospital in The Netherlands

Precise data on the utilization of health care facilities by HIV infected patients are generally not available. Nor are there data on the related cost, effectiveness and efficiency of the treatment provided. This is due mainly to the lack of a suitable method for recording demographic, medical and financial data on individual patients in hospitals. For this reason we have been developing a system of data collection, which provides a detailed cost record of each patient. The application of this system for 52 patients with HIV infection treated in a university hospital over a two-year period showed that for a patient with AIDS the mean cost of inpatient and outpatient hospital services was $19,507 per person-year. For patients with HIV infections other than AIDS the mean costs ranged from $1,769 for CDC III patients to $2,064 for CDC II patients (expressed in 1987 US dollars). Continued operation of the registration system will make it possible to analyze the causal background of costs as well as the cost-effectiveness of the treatment.     

AIDS scenarios for The Netherlands; the economic impact on hospitals

OBJECTIVE: To assess the economic impact of HIV/AIDS on the health care system in The Netherlands. Data and methods: Two types of data are used: (i) routine surveillance data on AIDS incidence and (ii) information on hospital resource utilisation and corresponding monetary costs. Progression of disease is modelled using a multi-stage model, with stages corresponding to clinical classifications and to different phases of health care need. Economic impact is analysed for all stages in three scenarios: the reference and two alternative scenarios. RESULTS: In the year 2000 hospital bed need would reach 220 beds if yearly new HIV infections in the 1990s remain at the level estimated for the end of the 1980s, and if the intensity of hospital care remains constant. A minimum need of 125 beds is projected if no new HIV infections occur in the 1990s. Hospital costs in 1993 are estimated to amount to 33.8 million ECUs. Scenarios indicate a range of 26.7-50.7 million ECUs for the year 2000 (price level: 1993). The proportion of the costs of hospital inpatient care and cure in total hospital costs increases, whereas the proportion for outpatient services decreases. Conclusions: Projected hospital bed need of 125-220 for HIV/AIDS in the year 2000 is limited compared to the projections for coronary heart disease and stroke, but approaches that for lung cancer, pneumonia and diabetes. We estimate hospital costs to have been 85% of total health care costs for HIV/AIDS in 1993. In 1993, the estimated proportions in hospital costs are 41% for inpatient care, 20% for inpatient cure and 39% for outpatient facilities. Our scenarios indicate a decreasing share of outpatient costs--possibly to 30% of total hospital costs for HIV/AIDS in 2000--illustrating the growing relative importance of the AIDS stage for the hospital costs. We project hospital costs for HIV/AIDS in 2000 to reach up to 0.53% of projected hospital costs for all diseases. A present value of 38 million ECUs (23%) of hospital costs projected in the reference scenario might be avoidable, during the period 1994-2000. However, with unchanged treatment patterns a present value of 127 million ECUs for hospital costs during the same period is projected to represent unavoidable costs (discount rate: 5%). In The Netherlands, data needs in the field of economic impact assessment of HIV/AIDS especially refer to registrations of non-hospital outpatient resource utilisation and costs.     

Associations between Outpatient and Inpatient Service Use among Persons with HIV Infection: A Positive or Negative Relationship?

Objective. To examine the prospective association between frequency of outpatient visits and subsequent inpatient admissions.
Data Sources. Medical record data on 13,942 patients with HIV infection seen in 10 HIV speciality care sites across the United States.
Study Design. This observational study followed a cohort of HIV-infected patients who were in care in the first half of 2001. Numbers of inpatient admissions and outpatient visits were calculated for each patient for each 3-month period, from 2001 through 2004.
Analysis. Negative binomial and logistic regression analyses using random-effects models examined the effects of inpatient admissions and outpatient visits in the previous period on inpatient and outpatient service utilization, controlling for background characteristics and HIV disease stage.
Results. For 3-month periods, between 5 and 9 percent of patients had an inpatient admission. The linear association between number of outpatient visits and any inpatient admission in the subsequent period was positive (adjusted odds ratio=1.05; 95 percent confidence interval [CI]=1.04, 1.06). However, patients with zero prior outpatient visits had significantly greater admission rates than those with one prior visit. Hospitalization rates were also higher among those with a prior hospitalization and those with more advanced HIV disease.
Conclusions. These results suggest a J-shaped relationship between outpatient use and inpatient use among persons with HIV disease. Those in worse health have greater utilization of both inpatient and outpatient care. However, having no outpatient visits may also increase the likelihood of subsequent hospitalization. Although outpatient care cannot be justified as a cost-saving mechanism, maintaining regular clinical monitoring of patients is important.     

The effects of immune status and race on health service use among people with HIV disease.

OBJECTIVES. The purpose of this study was to examine the relationship between CD4 lymphocyte count and health service use, and to determine whether differences in the rates of service use between Whites and people of color could be identified. METHODS. Medical records for 571 HIV-infected individuals were analyzed. Incidence rates and relative rates across CD4 strata (defined by cell counts) were calculated for inpatient and outpatient events. Rate ratios comparing people of color with Whites were estimated within strata, adjusting for confounding factors using a Mantel-Haenszel pooling procedure. RESULTS. Both inpatient and outpatient service use increased over progressively lower levels of CD4 counts. Within each CD4 stratum and controlling for other factors, White participants had more HIV clinic visits and fewer admissions than people of color. Among participants with fewer than 51 CD4 cells per cubic millimeter, people of color were admitted 20% more often, had 35% more inpatient days per person-year, and had only 74% as many HIV clinic visits as their White counterparts. CONCLUSIONS. These results indicate that CD4 lymphocyte count is strongly associated with increased usage of health services. People of color with HIV disease are more likely than similar Whites to be admitted to the hospital and less likely to use outpatient care.     

A method for estimating baseline health care costs.

STUDY OBJECTIVES--Studies estimating the cost of specific illnesses do not generally take into account the fact that health care costs would have been incurred in the absence of the disease of interest. The goal of this study was to develop a method of estimating age specific baseline health care costs. These costs were calculated for Australian men, and their magnitude was compared with the costs of caring for men with HIV infection. DESIGN--Information about health service usage was obtained from the 1989-90 national health survey and linked with data on the costs of services to obtain average monthly costs for individual and total health services. SETTING--The Australian community. PARTICIPANTS--Average total health service costs per man per month were $103 (Australian). Hospital admissions comprised approximately 40% of these costs and casualty/outpatient visits, consultations with a doctor, and prescribed medication comprised 10%, 13%, and 12%, respectively. Costs increased with age, from around $60 per month for men aged 20-39 years to $213 per month for men aged 60 and over. CONCLUSION--Baseline costs comprised around 18% of health care costs for men with asymptomatic HIV infection, but less than 1% of costs for men with AIDS. These estimates provide an essential baseline for determining the costs attributable to specific diseases.     

Mental health and substance abuse parity: a case study of Ohio's state employee program

BACKGROUND: In the United States, insurance benefits for treating alcohol, drug abuse and mental health (ADM) problems have been much more limited than medical care benefits. To change that situation, more than 30 states were considering legislation that requires equal benefits for ADM and medical care ("parity") in the past year. Uncertainty about the cost consequences of such proposed legislation remains a major stumbling block. There has been no information about the actual experience of implementing parity benefits under managed care or the effects on access to care and utilization. AIMS OF THE STUDY: Document the experience of the State of Ohio with adopting full parity for ADM care for its state employee program under managed care. Ohio provides an unusually long time series with seven years of managed behavioral health benefits, which allows us to study inflationary trends in a plan with unlimited ADM benefits. METHODS: Primarily a case study, we describe the implementation of the program and track utilization, and costs of ADM care from 1989 to 1997. We use a variety of administrative and claims data and reports provided by United Behavioral Health and the state of Ohio. The analysis of the utilization and cost effect of parity and managed care is pre-post, with a multiyear follow-up period. RESULTS: The switch from unmanaged indemnity care to managed carve-out care was followed by a 75% drop in inpatient days and a 40% drop in outpatient visits per 1000 members, despite the simultaneous increase in benefits. The subsequent years saw a continuous decline in inpatient days and an increased use of intermediate services, such as residential care and intensive outpatient care. The number of outpatient visits stabilized in the range of 500-550 visits per 1000. There was no indication that costs started to increase during the study period; instead, costs continued to decline. A somewhat different picture emerges when comparing utilization under HMOs with utilization under a carve-out with expanded benefits. In that case, the expansion of benefits led to a significant jump in outpatient utilization and intermediate services, while there was a small decrease in inpatient days. Insurance payments in 1996/1997 were almost identical to the estimated costs under HMOs in 1993. CONCLUSIONS: In contrast to the emerging inflation anxiety regarding overall health care costs, managed care can provide long-run cost containment for ADM care even when patient copayments are reduced and coverage limits are lifted. This may differentiate ADM care from medical care and reasons for this difference include the state of management techniques (more advanced for ADM care), complexity of treatments (much higher technology utilization in medical care) and demographic factors (medical, but not behavioral health, costs increase as the population ages). IMPLICATIONS FOR HEALTH POLICY: The experience of the state of Ohio demonstrates that parity level benefits for ADM care are affordable under managed care. It suggests that the concerns about costs that have stymied ADM policy proposals are unfounded, as long as one is willing to accept managed care. IMPLICATIONS FOR RESEARCH: The continuing decline in costs raises concerns that levels of care may become insufficient. While concerns about costs being too high dominate the policy hurdle for parity legislation at this moment, the next step in research is to address quality of care or health outcomes, areas about which even less is known than about costs.     

Depression, service utilization, and treatment costs among Medicare elderly: gender differences.

OBJECTIVE: To compare gender differences in mood disorders, service utilization, and health care costs among a random sample of Medicare elderly beneficiaries of Tennessee. DATA SOURCES: Medicare expenditure data from a 5% random sample of Tennessee Medicare beneficiaries (n = 35,673) were examined for 1991-1993. The physician reimbursement files provided data relative to ICD-9 diagnostic codes, physician visits, and the cost of physician services provided. Other service utilization and cost data were obtained for the sample from the outpatient, home health, skilled nursing, hospice and inpatient files. STUDY DESIGN: The dependent variables were: (i) patients with ICD-9 diagnosis for a mood disorder (major depression and other depression), (ii) service utilization (number of outpatient visits, skilled nursing visits, home health visits, physician visits, emergency visits, and inpatient days), and (iii) health care costs (dollar amount of physician cost, outpatient cost, inpatient cost, total mental health cost, total health cost, and other cost). The independent variable was gender. PRINCIPLE FINDINGS: Chi-square tests showed that among the patients with a mood disorder, females had a significantly higher incidence than males of major depression (1.3% vs. .4%, respectively, p < .001) and other depression (1.6% vs. .6%, respectively, p < .001). Further, t-test results indicated that females diagnosed with major depression utilized significantly more outpatient services than males (3.2 vs. 2.6, respectively, p < .04). Total health care costs for those with other depression were significantly higher for males than females ($15,060 vs. $10,240, respectively, p < .002). CONCLUSIONS: The results indicate that mood disorders, outpatient services, and total mental health costs are higher for females than males; however, total health care costs are higher for males than females.     

HIV/AIDS患者合并机会性感染 与卫生服务利用现状分析

摘要:目的　分析HIV/AIDS患者合并机会感染与卫生服务利用的现状。方法　采用随机整群抽样对HIV/AIDS患者进行合并机会性感染及卫生服务利用问卷调查。结果　HIV/AIDS患者合并机会性感染率为57.78%;HIV/AIDS未合并机会性感染者和合并机会性感染者两周患病率分别为38.60%和73.08%,差异有统计学意义（P＜0.05）;HIV/AIDS未合并机会性感染者和合并机会性感染者两周就诊率分别为49.12%和76.92%,差异有统计学意义（P＜0.05）;HIV/AIDS患者家庭经济困难占64.71%,是他们未就诊的主要原因;HIV/AIDS患者选择医疗机构就诊差异有统计学意义（P＜0.05）;HIV/AIDS未合并机会性感染者和合并机会性感染者年住院率分别为15.79%和20.51%,差异无统计学意义（P＞0.05）;HIV/AIDS患者选择医疗机构住院差异无统计学意义（P＞0.05）。结论　HIV/AIDS合并机会感染者卫生服务利用量大于未合并机会感染者,HIV/AIDS患者卫生服务利用与医疗机构、病程、居住地、经济条件有关。     

Patient risks, outcomes, and costs of voluntary HIV testing at five testing sites within a medical center

OBJECTIVES: The Centers for Disease Control and Prevention (CDC) recommends offering human immunodeficiency virus (HIV) testing to all patients in all high HIV-prevalence clinical settings. We evaluated programmatic aspects of HIV testing across multiple clinical settings within a single medical center. METHODS: We analyzed programmatic data of HIV testing in the Urgent Care Center (UCC), inpatient floors, outpatient primary care, a non-clinical Drop-In Center, and Emergency Department (ED). HIV testing was by oral mucosal transudate, venous blood samples, or rapid testing fingersticks, with Western blot confirmation. We compared the sociodemographics and behavioral risks of individuals undergoing HIV testing across the five sites and estimated costs per person tested and per HIV-positive test result. RESULTS: From 2002 to 2004, 16,750 HIV tests were conducted, with 229 (1.4%) previously unreported HIV infections diagnosed among 16,696 valid test results. HIV-positive prevalence was 1.5% for the UCC, 1.5% at the Drop-In Center, 1.4% for primary care, 1.2% for inpatient, and 0.6% in the ED. Behavioral risks were most prevalent in the UCC and the Drop-In Center. The cost per test was lowest in the UCC and highest in the Drop-In Center. The cost per previously unreported HIV infection was lowest in the UCC ($1,980) and highest in the ED ($9,724). CONCLUSIONS: Although a significant number of HIV infections were identified, the number of tests performed represents < 10% of all clinical visits. Due to personnel and time constraints, offering HIV testing to patients hierarchically in some settings of a high-volume medical center merits evaluation.