Institute of Pathogen Biology, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, PR China.
BMC Med. 2011 Jan 17;9:6. doi: 10.1186/1741-7015-9-6.
The Chinese government has provided health services to those infected by the human immunodeficiency virus (HIV) under the acquired immunodeficiency syndrome (AIDS) care policy since 2003. Detailed research on the actual expenditures and costs for providing care to patients with AIDS is needed for future financial planning of AIDS health care services and possible reform of HIV/AIDS-related policy. The purpose of the current study was to determine the actual expenditures and factors influencing costs for untreated AIDS patients in a rural area of China after initiating highly active antiretroviral therapy (HAART) under the national Free Care Program (China CARES).
A retrospective cohort study was conducted in Yunnan and Shanxi Provinces, where HAART and all medical care are provided free to HIV-positive patients. Health expenditures and costs in the first treatment year were collected from medical records and prescriptions at local hospitals between January and June 2007. Multivariate linear regression was used to determine the factors associated with the actual expenditures in the first antiretroviral (ARV) treatment year.
Five ARV regimens are commonly used in China CARES: zidovudine (AZT) + lamivudine (3TC) + nevirapine (NVP), stavudine (D4T) + 3TC + efavirenz (EFV), D4T + 3TC + NVP, didanosine (DDI) + 3TC + NVP and combivir + EFV. The mean annual expenditure per person for ARV medications was US$2,242 (US$1 = 7 Chinese Yuan (CNY)) among 276 participants. The total costs for treating all adverse drug events (ADEs) and opportunistic infections (OIs) were US$29,703 and US$23,031, respectively. The expenses for treatment of peripheral neuritis and cytomegalovirus (CMV) infections were the highest among those patients with ADEs and OIs, respectively. On the basis of multivariate linear regression, CD4 cell counts (100-199 cells/μL versus <100 cells/μL, P = 0.02; and ≥200 cells/μL versus <100 cells/μL, P < 0.004), residence in Mangshi County (P < 0.0001), ADEs (P = 0.04) and OIs (P = 0.02) were significantly associated with total expenditures in the first ARV treatment year.
This is the first study to determine the actual costs of HIV treatment in rural areas of China. Costs for ARV drugs represented the major portion of HIV medical expenditures. Initiating HAART in patients with higher CD4 cell count levels is likely to reduce treatment expenses for ADEs and OIs in patients with AIDS.
自 2003 年以来，中国政府一直在实施艾滋病关爱政策，为感染艾滋病毒（HIV）的人提供卫生服务。为了未来的艾滋病保健服务财务规划和可能的 HIV/AIDS 相关政策改革，需要对为艾滋病患者提供护理的实际支出和成本进行详细研究。本研究的目的是确定在中国农村地区实施国家免费护理计划（中国关怀）后开始接受高效抗逆转录病毒治疗（HAART）的未治疗艾滋病患者的实际支出和影响成本的因素。
本研究采用回顾性队列研究方法，在云南省和山西省进行，对 HIV 阳性患者提供 HAART 和所有医疗服务免费。2007 年 1 月至 6 月，从当地医院的病历和处方中收集了第一年治疗的卫生支出和费用。采用多元线性回归分析确定第一年抗逆转录病毒（ARV）治疗中与实际支出相关的因素。
中国关怀计划中常用的 5 种 ARV 方案包括：齐多夫定（AZT）+拉米夫定（3TC）+奈韦拉平（NVP）、司他夫定（D4T）+3TC+依非韦伦（EFV）、D4T+3TC+NVP、去羟肌苷（DDI）+3TC+NVP 和 Combivir+EFV。276 名参与者中，每人每年 ARV 药物的平均支出为 2242 美元（1 美元=7 元人民币）。所有不良反应事件（ADE）和机会性感染（OI）的总治疗费用分别为 29703 美元和 23031 美元。在 ADE 和 OI 患者中，治疗周围神经炎和巨细胞病毒（CMV）感染的费用最高。基于多元线性回归，CD4 细胞计数（100-199 个细胞/μL 与 <100 个细胞/μL，P=0.02；和≥200 个细胞/μL 与 <100 个细胞/μL，P<0.004）、居住在芒市（P<0.0001）、ADE（P=0.04）和 OI（P=0.02）与第一年 ARV 治疗的总支出显著相关。
这是第一项在中国农村地区确定 HIV 治疗实际费用的研究。ARV 药物的费用占艾滋病医疗支出的主要部分。在 CD4 细胞计数水平较高的患者中启动 HAART，可能会降低艾滋病患者的 ADE 和 OI 治疗费用。
