Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Ann Intern Med. 2010 Jan 5;152(1):18-25. doi: 10.7326/0003-4819-152-1-201001050-00006.
Antiretroviral therapy (ART) adherence predicts HIV disease progression and survival, but its effect on direct health care costs is unclear.
To determine the effect of ART adherence on direct health care costs among adults in a resource-limited setting.
Cohort study.
Aid for AIDS, a private-sector disease management program in South Africa.
6833 HIV-infected adults who started ART between 6 August 2000 and 30 April 2006.
Monthly direct health care costs authorized by Aid for AIDS were averaged over all months. Pharmacy claim adherence, expressed as a percentage, was categorized into quartiles, from 1 (lowest) to 4 (highest). Effects of covariates on monthly total costs were assessed with a 2-step model with logit for probability of nonzero costs and a generalized linear model (GLM).
Total mean monthly costs were $370 (SD, $644). Mean monthly costs of ART were $32 (SD, $18); hospitalizations, $151 (SD, $436); consultations, $76 (SD, $66); investigations, $37 (SD, $50); and non-ART medications, $53 (SD, $180). Total mean monthly costs ranged from $313 (SD, $598) for quartile 4 to $376 (SD, $657) for quartile 1. Hospitalization costs increased from 29% to 51% of total costs as adherence decreased. In the GLM 2-step model, moving from adherence quartile 1 to quartile 2, 3, or 4 increased the probability of having nonzero total monthly costs by 0.078, 0.15, and 0.21 percentage point, respectively (P < 0.001). For patients with nonzero costs, increasing adherence from quartile 1 to quartile 2, 3, or 4 decreased total monthly costs by $70, $133, and $192, respectively (P < 0.001). Moving from adherence quartiles 1 to 4 had the highest decrease in net overall median monthly health care costs (-$85 [interquartile range, -$116 to -$41]).
Indirect health care costs were not included. Experience may not reflect that of public HIV/AIDS programs.
High ART adherence was associated with lower mean monthly direct health care costs, particularly reduced hospitalization costs, in this South African HIV cohort.
抗逆转录病毒疗法（ART）的依从性可预测 HIV 疾病的进展和生存情况，但它对直接医疗保健成本的影响尚不清楚。
确定在资源有限的环境中，ART 依从性对成年人直接医疗保健成本的影响。
队列研究。
南非 Aid for AIDS，一个私营部门的疾病管理项目。
6833 名于 2000 年 8 月 6 日至 2006 年 4 月 30 日期间开始接受 ART 的 HIV 感染成年人。
Aid for AIDS 授权的每月直接医疗保健费用的平均值。药房报销依从性以百分比表示，分为四分之一，从 1（最低）到 4（最高）。使用逻辑回归评估对每月总费用有影响的协变量，以及广义线性模型（GLM）。
总平均每月费用为 370 美元（标准差，644 美元）。ART 的平均每月费用为 32 美元（标准差，18 美元）；住院费用为 151 美元（标准差，436 美元）；咨询费用为 76 美元（标准差，66 美元）；检查费用为 37 美元（标准差，50 美元）；非 ART 药物费用为 53 美元（标准差，180 美元）。总平均每月费用从第 4 四分位数的 313 美元（标准差，598 美元）到第 1 四分位数的 376 美元（标准差，657 美元）不等。随着依从性的降低，住院费用从总成本的 29%增加到 51%。在 GLM 两步模型中，从依从性第 1 四分位数移动到第 2、3 或 4 四分位数，非零总每月费用的概率分别增加了 0.078、0.15 和 0.21 个百分点（P < 0.001）。对于有非零费用的患者，依从性从第 1 四分位数增加到第 2、3 或 4 四分位数，每月总费用分别减少 70 美元、133 美元和 192 美元（P < 0.001）。从依从性第 1 四分位数到第 4 四分位数的变化导致净中位数每月医疗保健总成本下降幅度最大（-85 美元[四分位距，-116 至-41]）。
间接医疗保健成本未包括在内。经验可能无法反映公共 HIV/AIDS 计划的情况。
在南非的这项 HIV 队列研究中，较高的 ART 依从性与较低的平均每月直接医疗保健成本相关，特别是降低了住院费用。
Zotero 插件