Sansom Stephanie L, Anthony Monique N, Garland Wendy H, Squires Kathleen E, Witt Mallory D, Kovacs Andrea A, Larsen Robert A, Valencia Rosa, Pals Sherri L, Hader Shannon, Weidle Paul J, Wohl Amy R
US Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
AIDS Patient Care STDS. 2008 Feb;22(2):131-8. doi: 10.1089/apc.2006.0216.
From a trial comparing interventions to improve adherence to antiretroviral therapy-directly administered antiretroviral therapy (DAART) or an intensive adherence case management (IACM)-to standard of care (SOC), for HIV-infected participants at public HIV clinics in Los Angeles County, California, we examined the cost of adherence programs and associated health care utilization. We assessed differences between DAART, IACM, and SOC in the rate of hospitalizations, hospital days, and outpatient and emergency department visits during an average of 1.7 years from study enrollment, beginning November 2001. We assigned costs to health care utilization and program delivery. We calculated incremental costs of DAART or IACM v SOC, and compared those costs with savings in health care utilization among participants in the adherence programs. IACM participants experienced fewer hospital days compared with SOC (2.3 versus 6.7 days/1000 person-days, incidence rate ratio [IRR]: 0.34, 97.5% confidence interval [CI]: 0.13-0.87). DAART participants had more outpatient visits than SOC (44.2 versus 31.5/1000 person-days, IRR: 1.4; 97.5% CI: 1.01-1.95). Average per-participant health care utilization costs were $13,127, $8,988, and $14,416 for DAART, IACM, and SOC, respectively. Incremental 6-month program costs were $2,120 and $1,653 for DAART and IACM participants, respectively. Subtracting savings in health care utilization from program costs resulted in an average net program cost of $831 per DAART participant; and savings of $3,775 per IACM participant. IACM was associated with a significant decrease in hospital days compared to SOC and was cost saving when program costs were compared to savings in health care utilization.
在加利福尼亚州洛杉矶县的公共艾滋病毒诊所，针对感染艾滋病毒的参与者，我们进行了一项试验，比较了不同干预措施（直接给予抗逆转录病毒疗法[DAART]或强化依从性病例管理[IACM]）与标准治疗（SOC），并研究了依从性项目的成本及相关医疗保健利用情况。我们评估了从2001年11月研究入组开始，在平均1.7年的时间里，DAART、IACM和SOC在住院率、住院天数以及门诊和急诊科就诊次数方面的差异。我们为医疗保健利用和项目实施分配了成本。我们计算了DAART或IACM相对于SOC的增量成本，并将这些成本与依从性项目参与者在医疗保健利用方面的节省进行了比较。与SOC相比，IACM参与者的住院天数更少（2.3天对6.7天/1000人日，发病率比值[IRR]：0.34，97.5%置信区间[CI]：0.13 - 0.87）。DAART参与者的门诊就诊次数比SOC更多（44.2次对31.5次/1000人日，IRR：1.4；97.5%CI：1.01 - 1.95）。DAART、IACM和SOC的平均每位参与者医疗保健利用成本分别为13,127美元、8,988美元和14,416美元。DAART和IACM参与者的6个月项目增量成本分别为2,120美元和1,653美元。从项目成本中减去医疗保健利用方面的节省，得出每位DAART参与者的平均净项目成本为831美元；每位IACM参与者节省3,775美元。与SOC相比，IACM与住院天数显著减少相关，并且在将项目成本与医疗保健利用方面的节省进行比较时具有成本效益。
