艾滋病病毒感染者和艾滋病患者卫生服务利用及医疗费用的研究

目的 了解艾滋病病毒(HIV)感染者和艾滋病(AIDS)患者对卫生服务的利用及直接医疗费用。方法 于1999年12月对北京佑安医院收治的HIV感染者和AIDS患者进行回顾性研究。收集一般人口学特征、HIV感染及疾病进程的相关信息、过去一年内卫生服务利用情况及医疗费用资料。结果 共调查29例HIV感染者，其中17例(58．62％)为无症状期的HIV感染者，12例为AIDS患者。无症状期的HIV感染者平均每人年门诊6次，住院1．23次，每人年住院58．6天；AIDS患者平均每人年门诊7．8次，住院2．1次，住院200．2天。无症状期的HIV感染者平均每人年门诊费用为13729元，住院费用为4745元；AIDS患者平均每人年门诊及住院费用分别为15053元和22242元。既门诊又住院平均每人年的门诊及住院医疗费用，无症状期的HIV感染者为16248元，AIDS患者为36795元。结论 HIV感染者和AIDS患者医疗费用昂贵，对卫生服务的需求量大。需要进一步在更大范围内了解国内HIV感染者和AIDS患者对卫生服务利用的现状及需求。     

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.     

Identifying a Sample of HIV-Positive Beneficiaries From Medicaid Claims Data and Estimating Their Treatment Costs

Objectives. We sought to identify people living with HIV/AIDS from Medicare and Medicaid claims data to estimate Medicaid costs for treating HIV/AIDS in California. We also examined how alternate methods of identifying the relevant sample affect estimates of per capita costs.Methods. We analyzed data on Californians enrolled in Medicaid with an HIV/AIDS diagnosis reported in 2007 Medicare or Medicaid claims data. We compared alternative selection criteria by examining use of antiretroviral drugs, HIV-specific monitoring tests, and medical costs. We compared the final sample and average costs with other estimates of the size of California’s HIV/AIDS population covered by Medicaid in 2007 and their average treatment costs.Results. Eighty-seven percent (18 290) of potentially identifiable HIV-positive individuals satisfied at least 1 confirmation criterion. Nearly 80% of confirmed observations had claims for HIV-specific tests, compared with only 3% of excluded cases. Female Medicaid recipients were particularly likely to be miscoded as having HIV. Medicaid treatment spending for Californians with HIV averaged $33 720 in 2007.Conclusions. The proposed algorithm displays good internal and external validity. Accurately identifying HIV cases in claims data is important to avoid drawing biased conclusions and is necessary in setting appropriate HIV managed-care capitation rates.In 2010, the White House Office of National AIDS Policy outlined an ambitious National HIV/AIDS Strategy for the United States that called for evaluation strategies that would “obtain data (core indicators) that capture the care experiences of people living with HIV without substantial new investments.”1 Surveillance systems already in place in each state provide the Centers for Disease Control and Prevention with comprehensive data on incident HIV and AIDS cases.2 However, much less is known about the medical treatments received by people living with HIV/AIDS and the cost of those treatments.Much of the cost of HIV/AIDS treatment is borne by public insurance programs, principally Medicaid and Medicare. These 2 programs provide health insurance for more than half of people living with HIV/AIDS who are receiving care.3,4 The importance of Medicaid as a source of funding for HIV/AIDS treatment of low-income persons will grow substantially after full implementation of the Affordable Care Act, which eliminates the additional disability requirement for Medicaid eligibility in states accepting the Medicaid expansion, thereby extending coverage to nondisabled, low-income people living with HIV/AIDS in those states.Because of its prominent role in insuring low-income people living with HIV/AIDS, Medicaid can provide a rich source of data on the types and costs of treatments delivered to some of the most vulnerable individuals with HIV/AIDS. Insurance claims data can potentially allow us to monitor HIV/AIDS treatment without substantial new investments because most claims data are stored as computerized records. Claims data provide a comprehensive picture of medical care received from a variety of providers in multiple settings (outpatient, inpatient, laboratory, pharmacy), contain procedure codes that detail the services provided, and include cost of the treatment. By contrast, medical records tend to have smaller scope, in terms of both numbers of patients and services covered. Furthermore, medical records most often lack payment information.Insurance claims data can provide information on a large number of individuals, even among those with relatively low-prevalence conditions, which is valuable in reducing the variability of estimates of per capita expenditures. However, the greater precision afforded by large administrative data sets is of little value if estimates are based on an inappropriate sample. Claims data are primarily designed for billing purposes; thus, they generally lack clinical detail important for selecting cases with a particular disease.3,5 For example, claims data will document whether a laboratory test was performed, but not the test result. Therefore, analysts must rely on the diagnosis information on insurance claims.6 Professional medical records specialists code diagnoses on inpatient claims, leading to greater accuracy and reliability of diagnosis information coming from inpatient stays. However, diagnosis coding is more error-prone in the outpatient sector, which has accounted for an increasing percentage of HIV/AIDS care since 1996 when antiretroviral medication (ARV) began to dramatically reduce hospitalization for HIV/AIDS.7 This has increased the challenges of identifying people living with HIV/AIDS from insurance claims data.We applied a practical algorithm for identifying people living with HIV/AIDS in insurance claims data to estimate Medicaid costs for treating HIV/AIDS in California. We also examined how alternate methods of identifying the relevant sample affect estimates of per capita costs.     

Demograghic and socio-economic determinants of community and hospital services costs for people with HIV/AIDS in London.

We examined the influence of demographic, social and economic background of people with HIV/AIDS in London on total community and hospital services costs. This was a retrospective study of community and hospital service use, needs and costs based on structured questionnaires administered by trained interviewers and costing information obtained from the service purchasers and providers, based on two Genito-urinary Medicine clinics in London: the Jefferiss Wing at St. Mary's Hospital and Patric Clements at the Central Middlesex Hospital, London, England. The subjects were 225 HIV infected patients (105 asymptomatic, 59 symptomatic non-AIDS and 61 AIDS). We found that over and above well established determinants of health care costs for HIV infected people such as disease stage and transmission category, social and economic factors such as employment and support of a living-in partner significantly reduced community services costs. Private health insurance had a similar effect, though only a small proportion of HIV people had such cover. The cost of community services for HIV infected non-European Union nationals, mainly of African origin, was one quarter that for the European Union nationals. Community services costs were highest for heterosexually infected women and lowest for heterosexually infected men after adjusting for other factors. Hospital services costs were significantly higher for HIV infected people lacking educational qualifications and employment. We conclude that access to community care for HIV infected non-EU nationals appears to be very poor as the cost of their community services was one quarter that for the EU nationals after adjusting for the effects of transmission category, disease stage, living with a partner, employment and having a private health insurance. Additional incentives for informal care for HIV infected people could be a cost-effective way to improve their community health service provisions.     

Patterns of hospital care for patients with HIV infection and AIDS.

OBJECTIVE--The aims were to describe the use of inpatient resources by patients with HIV infection and patients with AIDS; to examine trends in service use over time; and to provide data for planners concerned with service provision for HIV infection. SETTING--An inner London health district reporting 9% of AIDS cases nationally. DESIGN--Data on survival times and inpatient and day care use of resources were derived from existing patient records or collected prospectively between 1983 (when the first case of AIDS was diagnosed in the district) and 31 March 1990. SUBJECTS--A total of 488 HIV positive patients of whom 396 had been diagnosed as having AIDS were studied. MEASUREMENTS AND MAIN RESULTS--Inpatient days consumed per annum; trends in the number of bed days per person year with AIDS; the lifetime inpatient use per AIDS patient; and the influence of survival on service use estimates were determined. Altogether 16.4% of a total 17,785 hospital inpatient days were attributable to HIV positive patients who did not fulfil the criteria for AIDS. For patients with AIDS, there was an initial increase in the intensity of inpatient use in 1987 when a dedicated HIV ward was opened. After 1988, however, inpatient use fell to 30.8 bed days per person year with AIDS. Patients diagnosed after April 1987 had noticeably longer survival times than those diagnosed earlier (a median of 17-18 months compared with a median of 10-11 months). From 214 lifetime service use records, it was estimated that patients with short survival (less than six months) would consume 36 days of inpatient care, while those expected to survive longer would consume approximately twice that number of days, irrespective of how much longer they survived. CONCLUSIONS--The data indicate less intensive use of inpatient care by AIDS patients over time, and hence the apparent ability to manage an increasing AIDS patient workload without a comparable increase in occupied bed days. Increases in the size of that workload and changes in the survival profile of patients, together with a relatively constant rate of service demand by longer survivors, however, will continue to place increasing strains on finite inpatient resources. Further research is needed to establish the extent to which the greater use of outpatient and community services can offset this.     

In-patient hospital use in the last years of life: a Western Australian population-based study

OBJECTIVES: To estimate the likelihood and costs of in-patient care in the last three years of life. METHODS: A population-based retrospective cohort study using linked hospital and death records to evaluate in-patient use by Western Australians who died in 2002. RESULTS: Age was unrelated to the likelihood of in-patient admission and inversely related to in-patient costs, after adjustment for sex, cause of death and proximity to death. In-patient costs increased in the final three quarters before death. In the last quarter before death, the predicted average quarterly in-patient cost increased 2.8 fold from quarter two and 3.8 fold from quarter three. CONCLUSIONS: Older decedents were not more likely to be hospitalised than younger decedents in the final three years of life. Moreover, once hospitalised, their in-patient costs were lower. In-patient costs were heavily concentrated in the three last quarters of life. IMPLICATIONS: Remaining lifetime is a significant predictor of in-patient costs. Failure to account for proximity to death will overemphasise the impact of population ageing on health care expenditure, because older people have a higher probability of dying.     

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.     

Correlates of medical service utilization among people with HIV infection.

OBJECTIVE. To examine factors affecting the use of inpatient, outpatient, and emergency room services by people with HIV infection. DATA SOURCES AND STUDY SETTING. Study participants are adults with HIV infection receiving services at major providers of medical care in ten U.S. cities. Six interviews were conducted over an 18-month period (March 1991 to September 1992). DATA COLLECTION METHODS. Data on service utilization, personal background characteristics, insurance status, and functional status are based on self-report. Disease stage is based on medical record data. STUDY DESIGN. This is an observational study using a panel survey design. Linear and Poisson regression analyses were conducted to determine the effects of need, enabling, and predisposing factors on the dependent variables of ambulatory visits, emergency room visits, inpatient admissions, and average length of inpatient stay. Analyses use 1,449 respondents who completed the second and third interviews. Independent variables were measured as of the second interview, while dependent variables were measured in the third and fourth interview periods. PRINCIPAL FINDINGS. Service utilization was higher among respondents with AIDS than among those at earlier stages of HIV infection. Functional limitations, experienced pain, and negative mood each were associated with increased service use, over and above disease stage. Black respondents reported more hospital admissions and longer lengths of inpatient stays than white respondents. Lack of insurance was related to reduced service use. The effects of disease stage and functional limitations were reduced among people with public, compared to private, insurance. CONCLUSIONS. While disease stage affects use of medical care, the experience of adverse HIV-related conditions, such as pain or functional limitations, has an additional effect on service use. Persistent racial differences in utilization remain to be explained. Lack of insurance impedes use directly and also modifies the effects of disease stage and functioning.     

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.     

Substituting inpatient for outpatient care: what is the impact on hospital costs and efficiency?

Substitution of inpatient for outpatient care is seen as a means to increase patient throughput and control costs. The purpose of this study was to assess the impact of increased outpatient care on hospital costs and efficiency using Finnish specialty-level data from years 2003–2006 to which we applied stochastic frontier analysis. The results reveal that outpatient services have a smaller impact on total costs than inpatient services. At the same time, increased outpatient activity appears to have an adverse effect on estimated cost efficiency. This counterintuitive finding is probably due to the low weight given to outpatient activities by the Diagnosis Related Groups (DRG) system. A common weighting for inpatient and outpatient services is required in order to assess accurately the impact of outpatient care on efficiency.     

Estimating hospital costs. A multiple-output analysis.

This study explores a new approach to estimating the cost of inpatient and outpatient services provided by hospitals. Data from a nationwide survey of non-federal, short-term, U.S. hospitals are used to make cost estimates based on a multiple-output cost function. The results provide information on the structure of hospital costs, and include estimates of the marginal and average incremental cost of outpatient care. Because of the innovative specification of the cost function, the study is of interest for its methodology as well as empirical results.     

Trends in inpatient treatment intensity among Medicare beneficiaries at the end of life

OBJECTIVE: Although an increasing fraction of Medicare beneficiaries die outside the hospital, the proportion of total Medicare expenditures attributable to care in the last year of life has not dropped. We sought to determine whether disproportionate increases in hospital treatment intensity over time among decedents are responsible for the persistent growth in end-of-life expenditures. DATA SOURCE: The 1985-1999 Medicare Medical Provider Analysis and Review (MedPAR) and Denominator files. STUDY DESIGN: We sampled inpatient claims for 20 percent of all elderly fee-for-service Medicare decedents and 5 percent of all survivors between 1985 and 1999 and calculated age-, race-, and gender-adjusted per-capita inpatient expenditures and rates of intensive care unit (ICU) and intensive procedure use. We used the decedent-to-survivor expenditure ratio to determine whether growth rates among decedents outpaced growth relative to survivors, using the growth rate among survivors to control for secular trends in treatment intensity. Data Collection. The data were collected by the Centers for Medicare and Medicaid Services. PRINCIPAL FINDINGS: Real inpatient expenditures for the Medicare fee-for-service population increased by 60 percent, from $58 billion in 1985 to $90 billion in 1999, one-quarter of which were accrued by decedents. Between 1985 and 1999 the proportion of beneficiaries with one or more intensive care unit (ICU) admission increased from 30.5 percent to 35.0 percent among decedents and from 5.0 percent to 7.1 percent among survivors; those undergoing one or more intensive procedure increased from 20.9 percent to 31.0 percent among decedents and from 5.8 percent to 8.5 percent among survivors. The majority of intensive procedures in the United States were performed in the more numerous survivors, although in 1999 50 percent of feeding tube placements, 60 percent of intubations/tracheostomies, and 75 percent of cardiopulmonary resuscitations were in decedents. The proportion of beneficiaries dying in a hospital decreased from 44.4 percent to 39.3 percent, but the likelihood of being admitted to an ICU or undergoing an intensive procedure during the terminal hospitalization increased from 38.0 percent to 39.8 percent and from 17.8 percent to 30.3 percent, respectively. One in five Medicare beneficiaries who died in the hospital in 1999 received mechanical ventilation during their terminal admission. CONCLUSIONS: Inpatient treatment intensity for all fee-for-service beneficiaries increased between 1985 and 1999 regardless of survivorship status. Absolute changes in per-capita hospital expenditures, ICU admissions, and intensive inpatient procedure use were much higher among decedents. Relative changes were similar except for ICU admissions, which grew faster among survivors. The secular decline in in-hospital deaths has not resulted in decreased per capita utilization of expensive inpatient services in the last year of life. This could imply that net hospital expenditures for the dying might have been even higher over this time period if the shift toward hospice had not occurred.     

Consequences of adult HIV infection for outpatient morbidity and treatment costs: a prospective study in a factory clinic in Tanzania

Most studies of the medical costs of HIV infection focus on the terminal stage of this chronic illness when the patients have developed AIDS or severe HIV disease and in-patient care dominates. Data are also needed on the medical costs during the prolonged phase of HIV infection preceding severe terminal illness and the effects it may have on the provision of outpatient care. The study population was derived from a cohort study of factory workers and their spouses in Tanzania. Morbidity and outpatient health services utilization are estimated for 1832 adults who on average had been enrolled for two years and utilized the study clinic. Among those who had been enrolled at least 2 years, 50 cases (HIV+ since enrollment) and 150 control (HIV- until last visit) were selected, matched by age, sex and income level to estimate expenditure on drugs by HIV status. There was an increase in morbidity during HIV infection: the incidence of clinical diagnoses was 30% higher among HIV-positive than among HIV-negative adults (p < 0.001). HIV-infected adults also made more frequent use of the outpatient services (23% higher utilization). Estimates of essential drug costs among the subsample showed a 15% increase for HIV infected adults compared to HIV-negative adults, caused by higher use of antibiotics and other antimicrobial drugs. The overall increase in morbidity, outpatient care services utilization and essential drug use due to HIV infection was limited, as HIV prevalence in this adult population was 11%. For example, the net proportion of all illness episodes attributable to HIV infection was 3.2%. Possible biases are discussed and suggest that our findings are a minimum estimate of the effect of adult HIV infection on outpatient care costs. There is a need for more studies in different settings to assess the impact of HIV infection on outpatient care in developing countries.     

The use of health services by women with HIV infection.

OBJECTIVE. The purpose of this study is to determine whether women who have been diagnosed with HIV utilize the same volume of medical care services as men who have been diagnosed with HIV. DATA SOURCES. This study uses data from the first wave of interviews of the AIDS Cost and Service Utilization Survey (ACSUS) conducted between May and July of 1991. The first wave of interviews involved 1,949 adults and adolescents, of whom 359 were women. STUDY DESIGN. The ACSUS sample was selected from 26 sites (hospitals, clinics, and physician offices) in ten cities chosen from the 25 cities with the most AIDS cases. Cities are located throughout the nation, and in low, medium, and high prevalence areas. The sites in each city are generally those that treat the highest number of persons with HIV infection. Patients at each site were chosen using disease stage (asymptomatic, symptomatic, and AIDS) and gender as the selection criteria. Utilization equations are estimated for AZT use, outpatient care, and hospitalization. DATA COLLECTION. The ACSUS involves six in-person interviews over an 18-month period. Interviews include questions about the use of medical and support services, insurance status, functional status, and barriers to care during the prior three-month period. PRINCIPAL FINDINGS. A male injection drug user (IDU) with AIDS is 20 percent more likely to be hospitalized than a woman with AIDS, and the hospital cost of treating a male IDU with AIDS is $9,180 more per year than the hospital cost of treating a woman with AIDS. CONCLUSIONS. This study shows that, even after being diagnosed and after having accessed the medical care system, women with AIDS receive fewer services than men with AIDS.     

The use and cost of health services prior to death: a comparison of the Medicare-only and the Medicare-Medicaid elderly populations.

Lack of data has limited research into the high cost and ethical dilemmas associated with care of the dying elderly. This study is based on a five-year, person-specific file of Medicare and Medicaid use and cost data for residents of Monroe County, New York, over the age of 65. It examines and compares utilization and expenditure patterns of the Medicare-only and the Medicare-Medicaid (dually eligible) decedents in 1988. Examination of reimbursement for nonacute services, not covered by Medicare, reveals that services for the "older old" may be less costly immediately prior to death than for younger decedents. However, when expenses in the year prior to the year of death are also counted, services for the dually eligible, older old decedents appear to be neither more nor less costly than for younger decedents. Distribution of expenses does, however, vary considerably with age. The younger decedents, aged 65 to 74, use 55 percent of their medical resources on hospital care, paid for by Medicare; the older old use 26 percent for hospital services and pay 67 percent for supportive care, reimbursed by Medicaid. The study suggests that medical intervention associated with dying is utilized more often and at a higher cost by younger decedents.     

Migration to rural areas by HIV patients: impact on HIV-related healthcare use.

OBJECTIVE: To evaluate the impact of patient migration on human immunodeficiency virus (HIV)-related healthcare use in a rural setting. DESIGN: Data were collected on all patients seeking medical care related to HIV infection at The University of Iowa HIV/acquired immunodeficiency syndrome (AIDS) clinic. Information was collected related to patient care, stage of illness, prior and current residence, and clinic and hospital use. SETTING: An outpatient clinic in a university hospital offering primary and consultative medical care for persons with HIV infection. PATIENTS: All patients scheduled into clinic reported a previous positive HIV serologic test. RESULTS: Forty-five percent (81 of 181) of patients reported moving to Iowa, yet no more than 11% (n = 20) moved out of the state during the same period of observation. Of patients meeting the Centers for Disease Control criteria for AIDS, 24% were diagnosed prior to moving to Iowa (18 of 74). Twenty-seven percent of AIDS-related inpatient days of hospitalization and 19% of AIDS-related outpatient clinic visits were used by persons diagnosed in another state. Lifetime charges totalled for eight patients ranged from $24,873 to $232,556, with a mean of $109,934. CONCLUSIONS: A substantial portion of HIV-related healthcare in our rural area was used by individuals who had migrated to or back to Iowa. Further understanding of the reasons for and the extent of HIV patient migration to rural areas is needed.     

The excess health care costs of KardioPro,an integrated care program for coronary heart disease prevention

Coronary heart disease (CHD) is a major cause of death and important driver of health care costs. Recent German health care reforms have promoted integrated care contracts allowing statutory health insurance providers more room to organize health care provision. One provider offers KardioPro, an integrated primary care-based CHD prevention program. As insurance providers should be aware of the financial consequences when developing optional programs, this study aims to analyze the costs associated with KardioPro participation. 13,264 KardioPro participants were compared with a propensity score-matched control group. Post-enrollment health care costs were calculated based on routine data over a follow-up period of up to 4 years. For those people who incurred costs, KardioPro participation was significantly associated with increased physician costs (by 33%), reduced hospital costs (by 19%), and reduced pharmaceutical costs (by 16%). Overall costs were increased by 4%, but this was not significant. Total excess costs per observation year were €131 per person (95% confidence interval: [€−36.5; €296]). Overall, KardioPro likely affected treatment as the program increased costs of physician services and reduced costs of hospital services. Further effects of substituting potential inpatient care with increased outpatient care might become fully apparent only over a longer time horizon.     

Patient classification and cost analysis of AIDS and HIV: the case of Belgium

The study calculates inpatient costs generated at the University Hospital in Antwerp (Belgium) and outpatient costs generated at the Institute of Tropical Medicine or at the University Hospital of 213 seropositive patients without AIDS and of 48 AIDS patients, for the year 1991. Outpatient drug use other than Zidovudine was excluded. An HIV + patient has an average annual total billing cost of 2062 ECU, 43% of which is spent in hospital, 29% on Zidovudine and 28% for follow-up at the Institute of Tropical Medicine. The average cost of care for an AIDS patient is 5.5 times higher and amounts to 11,277 ECU--hospitalisation costs (8349 ECU) and costs of Zidovudine (2031 ECU) are much higher. Costs vary with the severity of illness. In comparison to 1987, costs decreased due to lower drug prices and reduced hospitalisations. Life time costs of a seropositive patient are estimated at about 35,000 ECU, based on cost calculations per CD4-class for a follow-up period from 1991 to 1993.