Financing HIV service provision in England: estimated impact of the cost of antiretroviral combination therapy

被引:11
作者
Beck, EJ [1 ]
Tolley, K [1 ]
机构
[1] Imperial Coll Sci Technol & Med, Dept Epidemiol & Publ Hlth, NPMS Coordinating & Analyt Ctr, London W2 1PG, England
关键词
cost estimates; English HIV service provision; antiretroviral therapy;
D O I
10.1258/0956462981922746
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
The objective of this study was to provide population-based estimates on the cost of HN 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 these 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 HN infection. Using hospital prices, in 1996 the total annual cost estimate for HIV service provision amounted to pound 131m (range pound 83 m to pound 233 m), or pound 150 m (95% CI pound 126 m to pound 173 m) using standard costs, if all patients with HV disease were treated with AZT monotherapy. For all eligible patients to be treated with dual therapy, cost estimates amounted to pound 161m (range pound 126m to pound 173m) per year using hospital prices or pound 180 m (95% CI pound 156 m to pound 203 m) when using standard cost estimates, while for triple therapy annual estimated expenditure amounted to pound 204m per year (range pound 157 m to pound 306 m) when using hospsital prices or pound 223 m (95% CI pound 199 m to pound 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 prevision 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.
引用
收藏
页码:512 / 517
页数:6
相关论文
共 36 条
[1]  
Aber V, 1996, LANCET, V348, P283, DOI 10.1016/S0140-6736(96)05387-1
[2]   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
[3]   The use and cost of hospital services by London AIDS patients with different AIDS defining conditions [J].
Beck, EJ ;
Kupek, EJ ;
Wadsworth, J ;
Miller, DL ;
Pinching, AJ ;
Harris, JRW .
JOURNAL OF PUBLIC HEALTH MEDICINE, 1996, 18 (04) :457-464
[4]   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
[5]  
BECK EJ, 1997, SERVICE ACTIVITY STA
[6]  
BECK EJ, 1997, SERVICE ACTIVTY STAG
[7]  
BECK EJ, 1997, HOSP COMMUNITY SERVI
[8]  
BECK EJ, 1997, NPMS STEER GROUP M I
[9]  
Beck EJ., 1997, J HIV COMB THERAPY, V2, P29
[10]  
BROWN R, 1996, 11 INT C AIDS VANC C