Kuyper Laura M, Hogg Robert S, Montaner Julio S G, Schechter Martin T, Wood Evan
BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
J Urban Health. 2004 Dec;81(4):655-60. doi: 10.1093/jurban/jth148.
Estimated and potential medical costs of treating patients infected with human immunodeficiency virus (HIV) in urban areas of high HIV prevalence have not been well defined. We estimated the total medical cost of HIV disease among injection drug users in Vancouver, British Columbia, Canada, assuming stable and increasing HIV prevalence. Total medical costs were estimated by multiplying the average lifetime medical cost per person by the number of HIV-infected individuals. We assumed the cost of each HIV infection to be 150,000 Canadian dollars, based on empirical data, and HIV prevalence estimates were derived from the Vancouver Injection Drug Users Study (VIDUS) and external data sources. By use of Monte Carlo simulation methodology, we performed sensitivity analyses to estimate total medical cost, assuming the HIV prevalence remained stable at 31% and under a scenario in which the prevalence rose to 50%. Expected medical expenditures based on current HIV prevalence levels were estimated as 215,852,613 Canadian dollars. If prevalence rises to 50% as reported in other urban centers, the median estimated medical cost would be approximately 348,935,865 Canadian dollars. This represents a difference in the total costs between the two scenarios of 133,083,253 Canadian dollars. Health planners should consider that predicted medical expenditures related to the HIV epidemic among injection drug users in our setting may cost an estimated 215,852,613 Canadian dollars. If funding cannot be found for appropriate prevention interventions and the prevalence rises to 50%, a further 133,083,253 Canadian dollars may be required.
在艾滋病毒高流行率的城市地区，治疗感染人类免疫缺陷病毒（HIV）患者的估计和潜在医疗成本尚未明确界定。我们估算了加拿大不列颠哥伦比亚省温哥华注射吸毒者中艾滋病毒疾病的总医疗成本，假设艾滋病毒流行率保持稳定并上升。通过将每人的平均终身医疗成本乘以艾滋病毒感染个体数量来估算总医疗成本。基于实证数据，我们假设每例艾滋病毒感染的成本为150,000加元，艾滋病毒流行率估计值来自温哥华注射吸毒者研究（VIDUS）和外部数据源。通过使用蒙特卡罗模拟方法，我们进行了敏感性分析以估算总医疗成本，假设艾滋病毒流行率保持在31%稳定不变以及在流行率升至50%的情况下。根据当前艾滋病毒流行率水平估算的预期医疗支出为215,852,613加元。如果流行率如其他城市中心所报告的那样升至50%，估计的医疗成本中位数将约为3,489,35,865加元。这代表两种情况之间的总成本差异为133,083,253加元。卫生规划者应考虑到，在我们的环境中，与注射吸毒者中艾滋病毒流行相关预计的医疗支出可能估计为215,852,613加元。如果找不到资金用于适当的预防干预措施且流行率升至50%，可能还需要133,083,253加元。
