Gilden David E, Kubisiak Joanna M, Gilden Daniel M
JEN Associates Inc, Cambridge, Mass 02139, USA.
Am J Public Health. 2007 Jun;97(6):1053-9. doi: 10.2105/AJPH.2005.063636. Epub 2007 Apr 26.
The 1996 introduction of antiretroviral medications changed Medicare's role in providing HIV care. We analyzed Medicare's patient database in an effort to document the new HIV therapies' effects on expenditures and outcomes.
We examined the medical billing records of a 5% national Medicare sample from 1997 through 2003. The cohort was stratified by year and categorized by age, race/ethnicity, gender, and Medicare status. Population summaries were categorized according to presence of major chronic diseases and HIV-related conditions.
The number of Medicare beneficiaries with HIV increased from 42520 in 1997 to 76500 in 2003, whereas mortality among this group fell by 35%. HIV-associated infections declined by as much as 43% (mycoses). Heart and liver disease and diabetes increased by more than 50%. Adjusted annual per person Medicare expenditures fell 28%; expenditures were 49% higher for Blacks than for Whites.
Improved HIV medical management has led to fewer deaths and has shifted treatment toward chronic care. However, successful management is complicated by conditions that have not been historically linked to HIV and whose effects vary according to race/ethnicity.
1996年抗逆转录病毒药物的引入改变了医疗保险在提供艾滋病护理方面的作用。我们分析了医疗保险的患者数据库，以记录新型艾滋病疗法对支出和治疗结果的影响。
我们研究了1997年至2003年全国5%医疗保险样本的医疗账单记录。该队列按年份分层，并按年龄、种族/民族、性别和医疗保险状态进行分类。人口总结根据主要慢性病和艾滋病相关疾病的存在情况进行分类。
医疗保险艾滋病受益人数从1997年的42520人增加到2003年的76500人，而该群体的死亡率下降了35%。艾滋病相关感染下降了多达43%（真菌病）。心脏病、肝病和糖尿病增加了50%以上。调整后的人均年度医疗保险支出下降了28%；黑人的支出比白人高49%。
改善艾滋病医疗管理导致死亡人数减少，并使治疗转向慢性病护理。然而，成功的管理因一些与艾滋病历史上没有关联且影响因种族/民族而异的疾病而变得复杂。
