Postma M J, Jager J C, Dijkgraaf M G, Borleffs J C, Tolley K, Leidl R M
National Institute of Public Health and Environmental Protection, Department of Public Health Forecasting, The Netherlands.
Health Policy. 1995 Feb;31(2):127-50. doi: 10.1016/0168-8510(94)00696-2.
To assess the economic impact of HIV/AIDS on the health care system in The Netherlands.
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.
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.
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.
评估艾滋病毒/艾滋病对荷兰医疗保健系统的经济影响。
使用了两种类型的数据：（i）艾滋病发病率的常规监测数据，以及（ii）医院资源利用情况及相应货币成本的信息。疾病进展采用多阶段模型进行模拟，各阶段对应临床分类及不同的医疗保健需求阶段。在三种情景下分析了所有阶段的经济影响：参考情景和两种替代情景。
如果20世纪90年代每年新增艾滋病毒感染病例数维持在20世纪80年代末估计的水平，且医院护理强度保持不变，那么到2000年医院床位需求将达到220张。如果20世纪90年代没有新增艾滋病毒感染病例，预计最低床位需求为125张。1993年的医院成本估计为3380万欧洲货币单位。情景分析表明，2000年的成本范围在2670万至5070万欧洲货币单位之间（价格水平：1993年）。医院住院护理和治疗成本在医院总成本中的比例上升，而门诊服务成本的比例下降。
与冠心病和中风的预测相比，预计2000年艾滋病毒/艾滋病的医院床位需求为125 - 220张，数量有限，但接近肺癌、肺炎和糖尿病的床位需求。我们估计1993年医院成本占艾滋病毒/艾滋病医疗保健总成本的85%。1993年，估计医院成本中住院护理占41%，住院治疗占20%，门诊设施占39%。我们的情景分析表明门诊成本所占比例在下降——到2000年可能降至艾滋病毒/艾滋病医院总成本的30%——这说明艾滋病阶段对医院成本的相对重要性日益增加。我们预计2000年艾滋病毒/艾滋病的医院成本将达到所有疾病预计医院成本的0.53%。在1994 - 2000年期间，参考情景中预计的医院成本现值3800万欧洲货币单位（23%）可能是可避免的。然而，如果治疗模式不变，同期医院成本的现值预计为不可避免的成本1.27亿欧洲货币单位（贴现率：5%）。在荷兰，艾滋病毒/艾滋病经济影响评估领域的数据需求尤其涉及非医院门诊资源利用和成本的登记。
