Guaraldi Giovanni, Zona Stefano, Menozzi Marianna, Carli Federica, Bagni Pietro, Berti Alessandra, Rossi Elisa, Orlando Gabriella, Zoboli Giuliana, Palella Frank
Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
Clinicoecon Outcomes Res. 2013 Sep 23;5:481-8. doi: 10.2147/CEOR.S40607.
We hypothesized that the increased prevalence of noninfectious comorbidities (NICMs) observed among HIV-infected patients may result in increased direct costs of medical care compared to the general population. Our objective was to provide estimates of and describe factors contributing to direct costs for medical care among HIV-infected patients, focusing on NICM care expenditure.
A case-control study analyzing direct medical care costs in 2009. Antiretroviral therapy (ART)-experienced HIV-infected patients (cases) were compared to age, sex, and race-matched adults from the general population, included in the CINECA ARNO database (controls). NICMs evaluated included cardiovascular disease, hypertension, diabetes mellitus, bone fractures, and renal failure. Medical care cost information evaluated included pharmacy, outpatient, and inpatient hospital expenditures. Linear regression models were constructed to evaluate predictors of total care cost for the controls and cases.
There were 2854 cases and 8562 controls. Mean age was 46 years and 37% were women. We analyzed data from 29,275 drug prescription records. Positive predictors of health care cost in the overall population: HIV infection (β = 2878; confidence interval (CI) = 2001-3755); polypathology (β = 8911; CI = 8356-9466); age (β = 62; CI = 45-79); and ART exposure (β = 18,773; CI = 17,873-19,672). Predictors of health care cost among cases: Center for Disease Control group C (β = 1548; CI = 330-2766); polypathology (β = 11,081; CI = 9447-12,716); age < 50 years (β = 1903; CI = 542-3264); protease inhibitor exposure (per month of use; β = 69; CI = 53-85); CD4 count < 200 cells/mm(3) (β = 5438; CI = 3082-7795); and ART drug change (per change; β = 911; CI = 716-1106).
Total cost of medical care is higher in cases than controls. Lower medical costs associated with higher CD4 strata are offset by increases in the care costs needed for advancing age, particularly for NICMs.
我们推测，与普通人群相比，在艾滋病毒感染患者中观察到的非感染性合并症（NICM）患病率增加可能导致医疗护理直接成本增加。我们的目标是估计并描述导致艾滋病毒感染患者医疗护理直接成本的因素，重点是NICM护理支出。
一项病例对照研究，分析2009年的直接医疗护理成本。将有抗逆转录病毒治疗（ART）经验的艾滋病毒感染患者（病例）与来自普通人群的年龄、性别和种族匹配的成年人进行比较，后者纳入了CINECA ARNO数据库（对照）。评估的NICM包括心血管疾病、高血压、糖尿病、骨折和肾衰竭。评估的医疗护理成本信息包括药房、门诊和住院医院支出。构建线性回归模型以评估对照和病例的总护理成本预测因素。
有2854例病例和8562例对照。平均年龄为46岁，37%为女性。我们分析了29275份药物处方记录的数据。总体人群中医疗保健成本的阳性预测因素：艾滋病毒感染（β = 2878；置信区间（CI）= 2001 - 3755）；多种病理情况（β = 8911；CI = 8356 - 9466）；年龄（β = 62；CI = 45 - 79）；以及ART暴露（β = 18773；CI = 17873 - 19672）。病例中医疗保健成本的预测因素：疾病控制中心C组（β = 1548；CI = 330 - 2766）；多种病理情况（β = 11081；CI = 9447 - 12716）；年龄 < 50岁（β = 1903；CI = 542 - 3264）；蛋白酶抑制剂暴露（每月使用；β = 69；CI = 53 - 85）；CD4细胞计数 < 200个/mm³（β = 5438；CI = 3082 - 7795）；以及ART药物更换（每次更换；β = 911；CI = 716 - 1106）。
病例的医疗护理总成本高于对照。与较高CD4分层相关的较低医疗成本被年龄增长所需护理成本的增加所抵消，特别是对于NICM。
