Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Institute for Global Health, University College London, London, UK.
HIV Med. 2023 Nov;24(11):1115-1125. doi: 10.1111/hiv.13529. Epub 2023 Aug 28.
Understanding the health care activity and associated hospital costs of caring for people living with HIV is an important component of assessing the cost effectiveness of new technologies and for budget planning.
Data collected between 2010 and 2017 from an English HIV treatment centre were combined with national reference costs to estimate the rate of hospital attendances and costs per quarter year, according to demographic and clinical factors. The final dataset included records for 1763 people living with HIV, which was analysed using negative binomial regression models and general estimating equations.
People living with HIV experienced an unadjusted average of 0.028 (standard deviation [SD] 0.20) inpatient episodes per quarter, equivalent to one every 9 years, and 1.85 (SD 2.30) outpatient visits per quarter. The unadjusted mean quarterly cost per person with HIV (excluding antiretroviral drug costs) was £439 (SD 604). Outpatient appointments and inpatient episodes accounted for 88% and 6% of total costs, respectively. In adjusted models, low CD4 count was the strongest predictor of inpatient stays and outpatient visits. Low CD4 count and new patient status (having a first visit at the Trust in the last 6 months) were the factors that most increased estimated costs. Associations were weaker or less consistent for demographic factors (age, sex/sexual orientation/ethnicity). Sensitivity analyses suggest that the findings were generally robust to alternative parameter and modelling assumptions.
A number of factors predicted hospital activity and costs, but CD4 cell count and new patient status were the strongest. The study results can be incorporated into future economic evaluations and budget impact assessments of HIV-related technologies.
了解为艾滋病毒感染者提供护理的医疗活动和相关医院费用是评估新技术成本效益和预算规划的重要组成部分。
将 2010 年至 2017 年间从一家英国艾滋病毒治疗中心收集的数据与国家参考成本相结合，根据人口统计学和临床因素，估算每季度的住院率和成本。最终数据集包括 1763 名艾滋病毒感染者的记录，使用负二项回归模型和广义估计方程进行分析。
艾滋病毒感染者未经调整的平均每季度住院 0.028 次（标准差[SD] 0.20），相当于每 9 年 1 次，每季度门诊就诊 1.85 次（SD 2.30）。未经调整的每名艾滋病毒感染者每季度（不包括抗逆转录病毒药物费用）的人均费用为 439 英镑（SD 604）。门诊预约和住院治疗分别占总费用的 88%和 6%。在调整后的模型中，低 CD4 计数是住院和门诊就诊的最强预测因素。低 CD4 计数和新患者状态（在过去 6 个月内首次到信托机构就诊）是增加估计费用的主要因素。人口统计学因素（年龄、性别/性取向/种族）的相关性较弱或不太一致。敏感性分析表明，这些发现对于替代参数和建模假设通常是稳健的。
一些因素预测了医院活动和费用，但 CD4 细胞计数和新患者状态是最强的因素。研究结果可纳入未来与艾滋病毒相关技术的经济评估和预算影响评估。
