Rothbard Aileen B, Metraux Stephen, Blank Michael B
Center for Mental Health Policy and Services Research, University of Pennsylvania, 3535 Market Street, Room 3014, Philadelphia, PA 19104-2648, USA.
Psychiatr Serv. 2003 Sep;54(9):1240-6. doi: 10.1176/appi.ps.54.9.1240.
To assist in developing public policy about the feasibility of HIV prevention in community mental health settings, the cost of care was estimated for four groups of adults who were eligible to receive Medicaid: persons with serious mental illness and HIV infection or AIDS, persons with serious mental illness only, persons with HIV infection or AIDS only, and a control group without serious mental illness, HIV infection, or AIDS.
Claims records for adult participants in Medicaid fee-for-service systems in Philadelphia during 1996 (N=60,503) were used to identify diagnostic groups and to construct estimates of reimbursement costs by type of service for the year. The estimates included all outpatient and inpatient treatment costs per year per person and excluded pharmacy costs and the cost of nursing home care. Persons with severe mental illness, HIV infection, or AIDS had received those diagnoses between 1985 and 1996.
Persons with comorbid serious mental illness and HIV infection or AIDS had the highest annual medical and behavioral health treatment expenditures (about $13,800 per person), followed by persons with HIV infection or AIDS only (annual expenditures of about $7,400 per person). Annual expenditures for persons with serious mental illness only were about $5,800 per person. The control group without serious mental illness, HIV infection, or AIDS had annual expenditures of about $1,800 per person.
Given the high cost of treating persons with comorbid serious mental illness and HIV infection or AIDS, the integration of HIV prevention into ongoing case management for persons with serious mental illness who are at risk of infection may prove to be a cost-effective intervention strategy.
为协助制定关于在社区精神卫生环境中预防艾滋病毒可行性的公共政策，对四类符合医疗补助资格的成年人群的护理费用进行了估算：患有严重精神疾病且感染艾滋病毒或患艾滋病的人、仅患有严重精神疾病的人、仅感染艾滋病毒或患艾滋病的人，以及无严重精神疾病、未感染艾滋病毒或未患艾滋病的对照组。
利用1996年费城医疗补助服务收费系统成年参与者的理赔记录（N = 60,503）来确定诊断组，并构建该年度按服务类型划分的报销费用估算。估算包括每人每年的所有门诊和住院治疗费用，不包括药房费用和疗养院护理费用。患有严重精神疾病、感染艾滋病毒或患艾滋病的人在1985年至1996年期间被诊断出这些病症。
患有严重精神疾病且感染艾滋病毒或患艾滋病的人年度医疗和行为健康治疗支出最高（每人约13,800美元），其次是仅感染艾滋病毒或患艾滋病的人（每人年度支出约7,400美元）。仅患有严重精神疾病的人年度支出约为每人5,800美元。无严重精神疾病、未感染艾滋病毒或未患艾滋病的对照组每人年度支出约为1,800美元。
鉴于治疗患有严重精神疾病且感染艾滋病毒或患艾滋病的人的成本高昂，将艾滋病毒预防纳入对有感染风险的严重精神疾病患者的现行病例管理中可能是一种具有成本效益的干预策略。
