Beck E J, Kennelly J, McKevitt C, Whitaker L, Wadsworth J, Miller D L, Easmon C, Pinching A J, Harris J R
Academic Department of Public Health, St Mary's Hospital and Medical School, London, UK.
AIDS. 1994 Mar;8(3):367-77. doi: 10.1097/00002030-199403000-00012.
To describe the use of hospital-based services and associated costs over time for HIV-infected individuals by disease stage and year of treatment.
Data on service use were abstracted from inpatient and outpatient case-notes of 459 HIV-infected patients (121 asymptomatic and 338 AIDS patients) treated at St Mary's Hospital, London between 1983 and 1989. Cost estimates were derived from a survey of the 37 departments involved with HIV-related care. The number and type of admissions and outpatient visits, referral and discharge venues, number and type of tests and procedures performed, drugs prescribed and associated costs for the study period were the outcome measures used.
Most patients were homosexual men. At the time of first HIV-related visit, 80.7% lived in London. Most day cases and planned admissions were organized through the outpatient clinic; 31% of emergency admissions were initiated by patients themselves. For people with AIDS the number of day case admissions increased while planned admissions decreased. There was a marked reduction in the duration of inpatient stays, especially for AIDS patients. Costs associated with inpatient care decreased concomitantly. The number of outpatient visits for patients with symptomatic disease increased, resulting in increased outpatient expenditure. Asymptomatic patients had fewer inpatient tests, while outpatient tests did not change over time; costs followed similar patterns. Mean inpatient and outpatient drug-days prescribed did not change nor did average inpatient drug-costs although outpatient drug-costs increased. Inpatient tests performed on symptomatic non-AIDS patients decreased, while mean outpatient tests increased; average costs followed similar patterns. Inpatient drug-days prescribed and costs remained the same, while outpatient drug-days and average drug-costs increased during the study period. For AIDS patients, the number of inpatient tests performed and their average costs decreased but outpatient tests performed increased, though their average costs remained the same. Mean inpatient drug-days prescribed and average drug-costs decreased, while number of outpatient drug-days prescribed and average drug-costs increased markedly over time. For each disease category, expenditure on admissions and related tests decreased over time, while expenditure on outpatient visits and drug-costs increased.
The shift from an inpatient- to an outpatient-based service has resulted in fewer patients being investigated and treated in hospital and more as outpatients. This has resulted in a reduction of inpatient-related costs, while outpatient-related costs have increased. The overall contribution of drug-costs to the total cost has increased greatly over time. With the anticipated advent of new antiviral compounds, the importance of ascertaining their effectiveness as well as their efficacy will become crucial.
按疾病阶段和治疗年份描述随时间推移艾滋病毒感染者使用医院服务的情况及相关费用。
服务使用数据摘自1983年至1989年期间在伦敦圣玛丽医院接受治疗的459名艾滋病毒感染者（121名无症状感染者和338名艾滋病患者）的住院和门诊病历。成本估算来自对37个参与艾滋病毒相关护理部门的调查。研究期间的入院和门诊就诊次数及类型、转诊和出院地点、所进行检查和操作的次数及类型、所开药物及相关费用是所采用的结果指标。
大多数患者为男同性恋者。在首次进行与艾滋病毒相关的就诊时，80.7%的患者居住在伦敦。大多数日间病例和计划性入院是通过门诊诊所安排的；31%的急诊入院是患者自行发起的。对于艾滋病患者，日间病例入院次数增加而计划性入院次数减少。住院时间显著缩短，尤其是艾滋病患者。与住院护理相关的费用随之减少。有症状疾病患者的门诊就诊次数增加，导致门诊支出增加。无症状患者的住院检查较少，而门诊检查随时间没有变化；费用遵循类似模式。所开住院和门诊药物天数未变，住院药物平均费用也未变，尽管门诊药物费用增加。对有症状的非艾滋病患者进行的住院检查减少，而门诊检查平均次数增加；平均费用遵循类似模式。住院药物天数和费用保持不变，而在研究期间门诊药物天数和平均药物费用增加。对于艾滋病患者，所进行的住院检查次数及其平均费用减少，但门诊检查次数增加，尽管其平均费用保持不变。所开住院药物平均天数和平均药物费用减少，而门诊药物天数和平均药物费用随时间显著增加。对于每个疾病类别，入院和相关检查的支出随时间减少，而门诊就诊和药物费用的支出增加。
从以住院服务为主向以门诊服务为主的转变导致在医院接受检查和治疗的患者减少，门诊患者增多。这导致与住院相关的费用减少，而与门诊相关的费用增加。随着时间推移，药物费用在总成本中的总体占比大幅增加。随着新型抗病毒化合物的预期出现，确定其有效性和疗效的重要性将变得至关重要。
