The use and cost of hospital services by London AIDS patients with different AIDS defining conditions

被引:11
作者
Beck, EJ
Kupek, EJ
Wadsworth, J
Miller, DL
Pinching, AJ
Harris, JRW
机构
[1] ST MARYS HOSP & MED SCH,DEPT GENITOURINARY MED,LONDON,ENGLAND
[2] UNIV LONDON ST BARTHOLOMEWS HOSP MED COLL,DEPT IMMUNOL,LONDON,ENGLAND
来源
JOURNAL OF PUBLIC HEALTH MEDICINE | 1996年 / 18卷 / 04期
关键词
AIDS; casemix; service provision; costs;
D O I
10.1093/oxfordjournals.pubmed.a024545
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background Contracting for HIV service provision is now an established part of the National Health Service commissioning process. AIDS is a heterogeneous condition, comprising Various opportunistic illnesses which require different services and which have different resource implications. This study describes the use of hospital services and associated costs for the management of different AIDS defining conditions. Method A retrospective case-notes analysis was performed, of 335 AIDS patients treated at St Mary's Hospital, London, between 1 January 1983 end 30 September 1989, as well as a costing exercise of 37 clinical departments to calculate HIV-related costs. Results Mean age at time of AIDS diagnosis for these predominantly homosexual men was 38 years. Use of services varied. as did associated costs - from pound 8163 per patient-year for patients with Constitutional Disease to pound 42124 for those with Cytomegalovirus Disease. Most diagnostic categories showed a shift over the study period from an in-patient- to an out-patient-based service. Patients diagnosed after 1987 had overall lower costs per patient-year compared with those diagnosed before 1987; whereas out-patient costs for most groups had increased, in-patient expenditure decreased. For most categories, in-patient care costs and out-patient drugs prescribed provided the greatest proportion of total costs. Average costs per in-patient day ranged from pound 334 to pound 433, and average costs per out-patient visit ranged from pound 99 to pound 411 for different AIDS defining conditions. Conclusions Different opportunistic illnesses of symptomatic HIV disease have different treatment and resource implications. Casemix will need to be taken into consideration when contracting for HIV services, including extra-contractual referrals.
引用
收藏
页码:457 / 464
页数:8
相关论文
共 22 条
[1]   CHANGING USE OF HOSPITAL SERVICES AND COSTS AT A LONDON AIDS REFERRAL CENTER, 1983-1989 [J].
BECK, EJ ;
KENNELLY, J ;
MCKEVITT, C ;
WHITAKER, L ;
WADSWORTH, J ;
MILLER, DL ;
EASMON, C ;
PINCHING, AJ ;
HARRIS, JRW .
AIDS, 1994, 8 (03) :367-377
[2]   CHANGING PRESENTATION AND SURVIVAL, SERVICE UTILIZATION AND COSTS FOR AIDS PATIENTS - INSIGHTS FROM A LONDON REFERRAL CENTER [J].
BECK, EJ ;
WHITAKER, L ;
KENNELLY, J ;
MCKEVITT, C ;
WADSWORTH, J ;
MILLER, DL ;
EASMON, C ;
PINCHING, AJ ;
HARRIS, JRW .
AIDS, 1994, 8 (03) :379-384
[3]  
BECK EJ, 1991, HOSP SERVICE PROVISI
[4]  
BENNETT CL, 1991, J ACQ IMMUN DEF SYND, V4, P197
[5]  
*BRIT MED ASS ROYA, 1990, BRIT NATL FORMULARY
[6]  
CAMERON B, 1996, 3 C RETR OPP INF WAS
[7]   INPATIENT CARE FOR SYMPTOMATIC, HIV-INFECTED PERSONS - A LONGITUDINAL-STUDY OF HOSPITALIZATIONS, INPATIENT DRUG-USE, AND RELATED COSTS [J].
DIJKGRAAF, MGW ;
LUIJBEN, AHP ;
JAGER, JC ;
SCHRIJVERS, AJP ;
BORLEFFS, JCC .
AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, 1995, 7 (03) :321-336
[8]   TREATMENT WITH LAMIVUDINE, ZIDOVUDINE, OR BOTH IN HIV-POSITIVE PATIENTS WITH 200 TO 500 CD4+ CELLS PER CUBIC MILLIMETER [J].
ERON, JJ ;
BENOIT, SL ;
JEMSEK, J ;
MACARTHUR, RD ;
SANTANA, J ;
QUINN, JB ;
KURITZKES, DR ;
FALLON, MA ;
RUBIN, M .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 333 (25) :1662-1669
[9]   SEXUAL-BEHAVIOR AMONG LONDON GUM CLINIC ATTENDERS - IMPLICATIONS FOR HIV EDUCATION [J].
FILIPE, EMV ;
STRAUSS, SB ;
BECK, EJ ;
WHITAKER, L ;
WADSWORTH, J ;
RENTON, AM ;
GOLDMEIER, D ;
MILLER, DL .
INTERNATIONAL JOURNAL OF STD & AIDS, 1994, 5 (05) :346-352
[10]  
GAZZARD B, 1996, 3 C RETR OPP INF WAS