Beck E J, Tolley K
Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, London, UK.
Int J STD AIDS. 1998 Sep;9(9):512-7. doi: 10.1258/0956462981922746.
The objective of this study was to provide population-based estimates on the cost of HIV service provision in England and the use of dual or triple antiretroviral combination therapy. Contemporary cost estimates of treating HIV-infected individuals by clinical stage of HIV infection (indexed to 1995/96 prices) were linked to the number of diagnosed HIV-infected individuals using statutory medical services in England during 1996. Two cost measures were used: the first one was based on average hospital prices derived from a number of English HIV units. These results were compared with those estimated using standard unit costs obtained through specific costing studies performed at a national HIV referral centre. Overall annual expenditure on HIV service provision was estimated for different treatment scenarios as was expenditure by clinical stage of HIV infection. Using hospital prices, in 1996 the total annual cost estimate for HIV service provision amounted to pound sterling 131 m (range pound sterling 83 m to pound sterling 233 m), or pound sterling 150 m (95% CI pound sterling 126 m to pound sterling 173 m) using standard costs, if all patients with HIV disease were treated with AZT monotherapy. For all eligible patients to be treated with dual therapy, cost estimates amounted to pound sterling 161 m (range pound sterling 126 m to pound sterling 173 m) per year using hospital prices or pound sterling 180 m (95% CI pound sterling 156 m to pound sterling 203 m) when using standard cost estimates, while for triple therapy annual estimated expenditure amounted to pound sterling 204 m per year (range pound sterling 157 m to pound sterling 306 m) when using hospital prices or pound sterling 223 m (95% CI pound sterling 199 m to pound sterling 246 m) using standard costs. Increasingly costs will be more evenly distributed across the 3 stages of HIV infection, with a greater proportion of costs generated by HIV-infected individuals before the onset of AIDS. Using non-standardized hospital prices may systematically underestimate the real cost of service provision. Monitoring prospectively the use, cost and outcome of HIV service provision in a standardized format will provide information on the actual cost impact over the next 2-3 years of combination therapy compared with the scenario-based estimates produced in this paper.
本研究的目的是提供基于人群的英格兰艾滋病毒服务提供成本以及双重或三重抗逆转录病毒联合疗法使用情况的估计。按艾滋病毒感染临床阶段对治疗艾滋病毒感染者的当代成本估计（按1995/96年价格指数计算）与1996年英格兰使用法定医疗服务的确诊艾滋病毒感染者人数相关联。使用了两种成本衡量方法：第一种基于多个英格兰艾滋病毒治疗单位得出的平均医院价格。将这些结果与使用在一家国家艾滋病毒转诊中心进行的特定成本核算研究获得的标准单位成本估计的结果进行比较。针对不同治疗方案估计了艾滋病毒服务提供的年度总支出以及按艾滋病毒感染临床阶段划分的支出。使用医院价格时，1996年艾滋病毒服务提供的年度总成本估计为1.31亿英镑（范围为8300万英镑至2.33亿英镑），如果所有艾滋病毒感染者都接受齐多夫定单一疗法治疗，使用标准成本时则为1.5亿英镑（95%可信区间为1.26亿英镑至1.73亿英镑）。对于所有符合条件接受双重疗法治疗的患者，使用医院价格时每年成本估计为1.61亿英镑（范围为1.26亿英镑至1.73亿英镑），使用标准成本估计时为1.8亿英镑（95%可信区间为1.56亿英镑至2.03亿英镑），而对于三重疗法，使用医院价格时年度估计支出为每年2.04亿英镑（范围为1.57亿英镑至3.06亿英镑），使用标准成本时为2.23亿英镑（95%可信区间为1.99亿英镑至2.46亿英镑）。成本将越来越均匀地分布在艾滋病毒感染的三个阶段，艾滋病毒感染者在艾滋病发病前产生的成本所占比例将更大。使用非标准化的医院价格可能会系统性地低估服务提供的实际成本。以前瞻性、标准化的形式监测艾滋病毒服务提供的使用情况、成本和结果，将提供与本文基于情景的估计相比，联合疗法在未来两到三年内实际成本影响的信息。
