Krentz Hartmut B, Gill M John
Southern Alberta Clinic, Sheldon M Chumir Health Centre, No. 3223, 1213-4th St SW, Calgary, AB, Canada T2R 0X7.
AIDS Res Treat. 2012;2012:757135. doi: 10.1155/2012/757135. Epub 2011 Aug 29.
We describe the immediate- and longer-term direct medical costs of care for individuals diagnosed with HIV at CD4 counts <350/mm(3) ("late presenters"). We collected and stratified by initial CD4 count all inpatient, outpatient, and drug costs for all newly diagnosed patients accessing HIV care within Southern Alberta from 1/1/1995 to 1/1/2010. 59% of new patients were late presenters. We found significantly higher costs for late presenters, especially inpatient costs, during the first year after accessing care. Direct medical costs remained almost twice as high for late presenters in subsequent years compared to patients presenting with CD4 counts >350/mm(3) despite significantly their improved CD4 counts. The sustained high cost for late presenters has implications for recent recommendations for wider routine HIV testing and the earlier initiation of cART. Earlier diagnosis and treatment, while increasing the immediate expenditures within a population, may produce both direct and indirect cost savings in the longer term.
我们描述了CD4细胞计数<350/mm³的HIV感染者（“晚期就诊者”）接受治疗的近期和长期直接医疗费用。我们收集了1995年1月1日至2010年1月1日期间在艾伯塔省南部接受HIV治疗的所有新诊断患者的所有住院、门诊和药物费用，并按初始CD4细胞计数进行分层。59%的新患者为晚期就诊者。我们发现，晚期就诊者在开始接受治疗后的第一年费用显著更高，尤其是住院费用。尽管晚期就诊者的CD4细胞计数有显著改善，但在随后几年中，他们的直接医疗费用几乎是CD4细胞计数>350/mm³的患者的两倍。晚期就诊者持续的高费用对近期关于更广泛开展常规HIV检测和更早开始抗逆转录病毒治疗（cART）的建议有影响。早期诊断和治疗虽然会增加总体人群的近期支出，但从长期来看可能会带来直接和间接的成本节约。
