Postma M J, Tolley K, Leidl R M, Downs A M, Beck E J, Tramarin A M, Flori Y A, Santin M, Antoñanzas F, Kornarou H, Paparizos V C, Dijkgraaf M G, Borleffs J, Luijben A J, Jager J C
Department of Public Health Forecasting, Bilthoven, The Netherlands.
Health Policy. 1997 Aug;41(2):157-76. doi: 10.1016/s0168-8510(97)00019-5.
This study estimates the current and future hospital resources for AIDS patients in the European Union (EU), using multinational scenario analysis (EU Concerted Action BMH1-CT-941723). In collaboration with another EU-project ('Managing the Costs of HIV Infection'), six national European studies on the utilization of hospital care for AIDS have been selected to provide the data for our analysis. The selection criteria involve recentness, quality, comparability, accessibility and representativeness. Baseline hospital resource utilization is estimated for hospital inpatient days and outpatient contracts, using a standardized approach controlling for two severity stages of AIDS (chronic stage and late stage). The epidemiological part of the study is based on standard models for backcalculating HIV incidence and projecting AIDS incidence, prevalence and mortality. In the next step, baseline resource utilization is linked to epidemiological information in a mixed prevalence and mortality-based approach. Several scenarios render different future epidemiological developments and hospital resource needs. For the year 1999, hospital bed needs of 10,000-12,700 in the EU are indicated, representing an increase of 20-60% compared to the estimated current (1995) level. The projected range for 1999 corresponds to a maximum of 0.65% of all hospital beds available in the EU. The growth in the number of outpatient hospital contacts is projected to possibly exceed that of inpatient days up to 1.82 million in 1999. Our methodology illustrates that estimation of current and future hospital care for AIDS has to be controlled for severity stages, to prevent biases. Further application of the multinational approach is demonstrated through a 'what-if' analysis of the potential impact of combination triple therapy for HIV/AIDS. Estimation of the economic impact of other diseases could as well benefit from the severity-stages approach.
本研究采用多国情景分析方法（欧盟协同行动BMH1-CT-941723），对欧盟（EU）当前及未来艾滋病患者所需的医院资源进行了估算。与欧盟的另一个项目（“管理艾滋病毒感染成本”）合作，选取了六项关于欧洲国家艾滋病患者医院护理利用情况的研究，为我们的分析提供数据。选择标准包括时效性、质量、可比性、可获取性和代表性。采用标准化方法，针对艾滋病的两个严重阶段（慢性阶段和晚期阶段）进行控制，估算了医院住院天数和门诊合同的基线医院资源利用率。该研究的流行病学部分基于用于回溯艾滋病毒发病率以及预测艾滋病发病率、患病率和死亡率的标准模型。下一步，采用基于患病率和死亡率的混合方法，将基线资源利用率与流行病学信息联系起来。几种情景呈现出不同的未来流行病学发展情况和医院资源需求。对于1999年，预计欧盟所需医院病床数为10000 - 12700张，与估计的当前（1995年）水平相比增加了20% - 60%。1999年的预测范围相当于欧盟所有可用医院病床的0.65%。预计到1999年，门诊医院接触次数的增长可能超过住院天数，达到182万次。我们的方法表明，对当前及未来艾滋病患者医院护理的估算必须针对严重阶段进行控制，以防止偏差。通过对艾滋病毒/艾滋病联合三联疗法潜在影响的“假设分析”，展示了多国方法的进一步应用。对其他疾病经济影响的估算也可从严重阶段方法中受益。
