Southern Alberta Clinic, Sheldon M Chumir Health Centre, #3223, 1213-4th St SW, Calgary AB T2R 0X7, Canada.
Health Policy. 2011 Dec;103(2-3):124-9. doi: 10.1016/j.healthpol.2011.08.003. Epub 2011 Sep 3.
To compare the direct cost of care for Canadian and non-Canadian born HIV patients accessing initial HIV care.
Drug, inpatient, and outpatient costs were collected for patients initiating HIV care at the Southern Alberta Clinic between 1/1/2000 and 3/31/2008 and followed until 3/31/2009. Demographic/clinical characteristics were obtained at initial visit. Country of birth determined Canadian (CBP) vs. foreign born (FBP) patients. Costs are mean cost per patient per month (PPPM) in 2009 Cdn$.
Of 281 patients, 103 were FBP. 86% were born in sub-Saharan Africa. FBP were more likely to be female (87% vs. 50%), younger (median 33 vs. 38 years), and heterosexual (93 vs. 35%)(all p<.01) compared to CBP. 74% FBP had CD4<350/mm(3) at initial visit compared to 61% of CBP (p<.05). Subsequent health outcomes for FBP/CBP were similar. Total mean costs PPPM were higher for CBP ($1174 vs. $1067, p<.05), and higher for all CD4 categories primarily due to the costs of non-HIV admissions among CBP injecting drug users (IDU), a risk group not represented within the FBP population of this study. Drugs costs were higher for FBP but lower for inpatient and outpatient costs.
Once engaged in regular HIV treatment and care, costs and outcomes for FBP were not significantly higher than CBP. Policy decisions concerning FBP with HIV should not be based solely on cost issues.
比较接受初始 HIV 护理的加拿大和非加拿大出生的 HIV 患者的直接护理成本。
收集了 2000 年 1 月 1 日至 2008 年 3 月 31 日期间在南艾伯塔诊所首次接受 HIV 护理的患者的药物、住院和门诊费用，并随访至 2009 年 3 月 31 日。在首次就诊时获得人口统计学/临床特征。通过出生地确定加拿大出生（CBP）与外国出生（FBP）患者。成本为 2009 年加拿大元每位患者每月的平均成本（PPPM）。
在 281 名患者中，有 103 名是 FBP。86%的患者来自撒哈拉以南非洲。FBP 更有可能是女性（87%比 50%）、年轻（中位数 33 比 38 岁）和异性恋（93%比 35%）（所有 p<.01），与 CBP 相比。在首次就诊时，74%的 FBP 的 CD4<350/mm(3)，而 CBP 的这一比例为 61%（p<.05）。FBP/CBP 的后续健康结果相似。CBP 的总平均成本 PPPM 更高（$1174 比 $1067，p<.05），并且在所有 CD4 类别中更高，主要是由于 CBP 注射吸毒者（IDU）的非 HIV 入院费用较高，这一风险群体在本研究的 FBP 人群中没有代表。FBP 的药物成本较高，但住院和门诊费用较低。
一旦开始接受常规 HIV 治疗和护理，FBP 的成本和结果并不明显高于 CBP。关于 HIV 患者的 FBP 的政策决策不应仅基于成本问题。
