Seage G R, Landers S, Lamb G A, Epstein A M
Division of Public Health, Boston Department of Health and Hospital, MA 02118.
Am J Public Health. 1990 Jul;80(7):835-9. doi: 10.2105/ajph.80.7.835.
We performed a two-year cost of illness study of 240 AIDS patients (55 percent of all Massachusetts cases) diagnosed and treated at five hospitals from March 1984 through February 1986. Sociodemographic and clinical data as well as information on medical utilization were obtained from review of inpatient and outpatient hospital records. The yearly inpatient cost per patient decreased by 28 percent from $38,369 in year one to $27,714 in year two. These changes were related to shorter lengths of stay (from 20.6 days to 16.8 days per hospitalization, mean difference of 3.8 days, 95% CI of the difference -.2, 7.8), and less costly hospitalizations (from $12,463 to $9,957, mean difference of $2,506, 95% CI of the difference $135, $4,877). The probability of hospitalization, however, was similar in both years. These patterns of care were still evident after controlling for transmission category, race, site, mortality, insurance, age, gender, number and type of opportunistic diseases and time since diagnosis. Although the cost per patient per year decreased between years one and two, median survival increased by 70 percent (from 10 to 17 months). Hence overall estimated lifetime costs increased by 24 percent.
我们对1984年3月至1986年2月期间在五家医院诊断和治疗的240名艾滋病患者（占马萨诸塞州所有病例的55%）进行了为期两年的疾病成本研究。通过查阅住院和门诊病历，获取了社会人口统计学和临床数据以及医疗利用信息。每位患者的年度住院成本从第一年的38,369美元降至第二年的27,714美元，下降了28%。这些变化与住院时间缩短有关（每次住院从20.6天降至16.8天，平均差异为3.8天，差异的95%置信区间为-0.2, 7.8），以及住院费用降低（从12,463美元降至9,957美元，平均差异为2,506美元，差异的95%置信区间为135美元, 4,877美元）。然而，两年的住院概率相似。在控制了传播类别、种族、发病部位、死亡率、保险、年龄、性别、机会性疾病的数量和类型以及诊断后的时间后，这些护理模式仍然明显。尽管每名患者每年的成本在第一年和第二年之间有所下降，但中位生存期增加了70%（从10个月增至17个月）。因此，总体估计终身成本增加了24%。
