Min Li, Qunwei Wang
College of Economics and Management, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, China.
Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China.
J Family Med Prim Care. 2023 Feb;12(2):352-359. doi: 10.4103/jfmpc.jfmpc_1765_22. Epub 2023 Feb 28.
To subdivide the antiretroviral therapy (ART) human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients by modeling the CD4 cell count variable, with an aim to reduce the medical burden from lifelong ART.
The data of outpatients at the research unit between August 2009 and December 2020 were exported and mined. A recency-frequency (RF) model was established for data subdivision, and data of non-churn ART patients were preserved. Common factor analysis (CFA) was conducted on the three indicators of the baseline/mean/last CD4 cell counts to obtain critical variables; then, k-means modeling was used to subdivide ART patients and their medical burden was analyzed.
A total of 12,106 samples of non-churn ART patients were preserved by RF modeling. The baseline/mean/last CD4 cell counts served as important variables employed for modeling. The patients were divided into 15 types, including two types with poor compliance and poor immune reconstitution, two types with good compliance but poor immune reconstitution, four types with poor compliance but good immune reconstitution, and seven types with good compliance and good immune reconstitution. The frequency of visits was 5.25-9.95 visits/person/year, and the percentage of examination fees was 44.24%-59.05%, with a medical burden of 4114.24-12,676.66 yuan/person/year, of which 42.62%-70.09% was reduced.
The CD4 cell count is not only an important indicator for judging post-ART immune recovery, but also a major modeling variable in subdividing ART patients with varying medical burdens. Poor compliance and poor immune reconstitution lead to excessive visits and frequent examinations, which were the leading causes of the heavy medical burden of ART.
通过对CD4细胞计数变量进行建模，对接受抗逆转录病毒疗法（ART）的人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征（AIDS）患者进行细分，以减轻终身ART带来的医疗负担。
导出并挖掘2009年8月至2020年12月研究单位门诊患者的数据。建立近因频率（RF）模型进行数据细分，保留未中断ART治疗患者的数据。对基线/平均/末次CD4细胞计数的三个指标进行共同因子分析（CFA）以获得关键变量；然后，使用k均值建模对ART患者进行细分并分析其医疗负担。
通过RF建模保留了12106例未中断ART治疗患者的样本。基线/平均/末次CD4细胞计数作为建模的重要变量。患者被分为15种类型，包括2种依从性差且免疫重建不良的类型、2种依从性好但免疫重建不良的类型、4种依从性差但免疫重建良好的类型和7种依从性好且免疫重建良好的类型。就诊频率为5.25 - 9.95次/人/年，检查费用占比为44.24% - 59.05%，医疗负担为4114.24 - 12676.66元/人/年，其中减轻了42.62% - 70.09%。
CD4细胞计数不仅是判断ART后免疫恢复的重要指标，也是细分不同医疗负担ART患者的主要建模变量。依从性差和免疫重建不良导致就诊次数过多和检查频繁，这是ART医疗负担沉重的主要原因。
