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高效抗逆转录病毒治疗时代的艾滋病医疗费用。

Costs of HIV medical care in the era of highly active antiretroviral therapy.

作者信息

Gebo K A, Chaisson R E, Folkemer J G, Bartlett J G, Moore R D

机构信息

Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.

出版信息

AIDS. 1999 May 28;13(8):963-9. doi: 10.1097/00002030-199905280-00013.

Abstract

OBJECTIVES

In the USA, Medicaid is the principal payer of the health care costs of patients with HIV infection. We wished to determine how the costs to Medicaid of patients in Maryland infected with HIV have changed in the setting of highly active antiretroviral treatment.

DESIGN

Observational cohort study.

METHODS

Analysis of combined economic and clinical data of patients from the Johns Hopkins HIV Service, the provider of primary and sub-specialty care for a majority of HIV-infected patients in the Baltimore metropolitan region. All patients were enrolled in Medicaid and received care longitudinally in Maryland from 1 January 1995 through 31 December 1997. Monthly Medicaid payments were calculated for all inpatient and outpatient services by fiscal year, CD4 cell count, and use of protease inhibitors.

RESULTS

For inpatients with a CD4 cell count < or = 50 x 10(6) cells/l, the total health care average monthly payments remained unchanged ($2629 in 1995, $2585 in 1997). Total mean monthly payments increased for those with a CD4 cell count > 50 x 10(6) cells/l (CD4 cell count 50-200 x 10(6) cells/l, $1172 in 1995 and $1615 in 1997, P < 0.05; CD4 cell count 201-500 x 10(6) cells/l, $1078 in 1995 and $1305 in 1997, P < 0.05). However, when data were stratified according to use of a protease inhibitor-containing regimen (used during approximately 50% of follow-up time in 1996-1997) it was found that hospital inpatient payments decreased significantly in all CD4 strata for patients on a protease inhibitor-containing regimen whereas pharmacy payments increased significantly. Inpatient payments associated with treating opportunistic illness were lower in 1996-1997 for patients receiving protease inhibitor therapy compared with those not receiving protease inhibitors. On balance, total health care payments tended to be slightly lower for patients receiving a protease inhibitor regimen.

CONCLUSION

Although protease inhibitor-containing antiretroviral regimens are being used by only about half of our Medicaid-insured patients, when they are used, there are significantly lower hospital inpatient and community care costs, as well as lower costs associated with the treatment of opportunistic illness. Even with the concurrent increase in their pharmacy costs, total health care costs were stable or slightly lower for these patients. We believe this is a favorable result suggesting a good clinical value being achieved without an increase in costs.

摘要

目的

在美国,医疗补助计划是艾滋病病毒感染患者医疗费用的主要支付方。我们希望确定在高效抗逆转录病毒治疗的背景下,马里兰州艾滋病病毒感染患者的医疗补助计划费用发生了怎样的变化。

设计

观察性队列研究。

方法

对约翰霍普金斯艾滋病服务中心患者的经济和临床数据进行综合分析,该中心为巴尔的摩大都市区大多数艾滋病病毒感染患者提供初级和专科护理。所有患者均参加了医疗补助计划,并于1995年1月1日至1997年12月31日在马里兰州接受长期护理。按财政年度、CD4细胞计数和蛋白酶抑制剂的使用情况计算所有住院和门诊服务的每月医疗补助支付金额。

结果

对于CD4细胞计数≤50×10⁶个/升的住院患者,每月医疗保健总平均支付金额保持不变(1995年为2629美元,1997年为2585美元)。CD4细胞计数>50×10⁶个/升的患者每月总平均支付金额有所增加(CD4细胞计数为50 - 200×10⁶个/升,1995年为1172美元,1997年为1615美元,P<0.05;CD4细胞计数为201 - 500×10⁶个/升,1995年为1078美元,1997年为1305美元,P<0.05)。然而,当根据含蛋白酶抑制剂方案的使用情况进行分层分析(1996 - 1997年约50%的随访时间使用)时发现,接受含蛋白酶抑制剂方案治疗的患者在所有CD4分层中住院支付金额显著下降,而药房支付金额显著增加。与未接受蛋白酶抑制剂治疗的患者相比,1996 - 1997年接受蛋白酶抑制剂治疗的患者治疗机会性疾病的住院支付金额较低。总体而言,接受蛋白酶抑制剂方案治疗的患者医疗保健总支付金额往往略低。

结论

尽管我们参加医疗补助计划的患者中只有约一半使用含蛋白酶抑制剂的抗逆转录病毒方案,但使用该方案时,住院和社区护理成本显著降低,治疗机会性疾病的成本也降低。即使其药房成本同时增加,这些患者的医疗保健总成本稳定或略低。我们认为这是一个有利结果,表明在不增加成本的情况下实现了良好的临床价值。

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