Mullins C D, Whitelaw G, Cooke J L, Beck E J
University of Maryland School of Pharmacy, Baltimore 21201, USA.
Clin Ther. 2000 Nov;22(11):1333-45. doi: 10.1016/s0149-2918(00)83030-1.
Few studies have estimated the indirect costs of care for HIV infection in England by stage of infection at a population level.
This study estimated annual indirect costs of the HIV epidemic in England in 1997-1998 from both a public-sector and societal perspective.
Service costs for HIV-infected individuals were indexed to 1997-1998 English prices. Average annual indirect costs included the costs of statutory, community, and informal services; disability payments; and lost economic productivity by stage of HIV infection. Disability payments were excluded from the societal perspective, whereas the degree of lost economic productivity was varied for the sensitivity analyses. Total average annual indirect costs by stage of HIV infection were calculated, as were population-based costs by stage of HIV infection and overall population costs.
Annual indirect costs from the public-sector and societal perspectives, respectively, ranged from pound sterling 3169 (dollars 5252) to pound sterling 3931 (dollars 6515) per person-year for asymptomatic individuals, pound sterling 5302 (dollars 8787) to pound sterling 7929 (dollars 13,140) for patients with symptomatic non-AIDS, and pound sterling 9956 (dollars 16,499) to pound sterling 21,014 (dollars 34,825) for patients with AIDS. Estimated population-based indirect costs from the public-sector perspective varied between pound sterling 109 million (dollars 181 million) and pound sterling 145 million (dollars 241 million) for 1997-1998, respectively, comprising between 58% and 124% of direct treatment costs for triple drug therapy in England during 1997. From the societal perspective, estimated population-based costs varied between pound sterling 84 million (dollars 138 million) and pound sterling 119 million (dollars 198 million) in 1997-1998, comprising between 45% and 102% of direct treatment costs and cost of care, respectively, during 1997.
Average indirect costs increase as HIV-infected individuals' illness progresses. Whether one takes a public-sector or societal perspective, indirect costs add a considerable amount to the cost of delivering health care to HIV-infected individuals. Both direct and indirect costs, when obtainable, should be used to assess the economic consequences of HIV infection and treatment interventions.
在英国，很少有研究在人群层面按感染阶段估算艾滋病毒感染护理的间接成本。
本研究从公共部门和社会角度估算了1997 - 1998年英国艾滋病毒流行的年度间接成本。
将艾滋病毒感染者的服务成本按1997 - 1998年英国物价指数进行调整。年度平均间接成本包括法定、社区和非正式服务成本、残疾抚恤金以及按艾滋病毒感染阶段计算的经济生产力损失。从社会角度排除了残疾抚恤金，而在敏感性分析中经济生产力损失程度有所不同。计算了按艾滋病毒感染阶段划分的年度间接成本总额、按艾滋病毒感染阶段划分的基于人群的成本以及总体人群成本。
从公共部门和社会角度来看，无症状感染者的年度间接成本分别为每人每年3169英镑（5252美元）至3931英镑（6515美元），有症状非艾滋病患者为5302英镑（8787美元）至7929英镑（13140美元），艾滋病患者为9956英镑（16499美元）至21014英镑（34825美元）。从公共部门角度估算的基于人群的间接成本在1997 - 1998年分别在1.09亿英镑（1.81亿美元）至1.45亿英镑（2.41亿美元）之间，分别占1997年英国三联药物疗法直接治疗成本的58%至124%。从社会角度来看，1997 - 1998年基于人群的成本估算在8400万英镑（1.38亿美元）至1.19亿英镑（1.98亿美元）之间，分别占1997年直接治疗成本和护理成本的45%至102%。
随着艾滋病毒感染者病情进展，平均间接成本会增加。无论从公共部门还是社会角度来看，间接成本都使为艾滋病毒感染者提供医疗保健的成本大幅增加。在可获取时，直接成本和间接成本都应用于评估艾滋病毒感染及治疗干预的经济后果。
