The use and cost of HIV service provision in England in 1996

Beck, EJ Tolley, K Power, A Mandalia, S Rutter, P Izumi, J Beecham, J Gray, A Barlow, D Easterbrook, P Fisher, M Innes, J Kinghorn, G Mandel, B Pozniak, A Tang, A Tomlinson, D Williams, I

Ej. Beck et al., The use and cost of HIV service provision in England in 1996, PHARMACOECO, 14(6), 1998, pp. 639-652

48

INGLESE

Article

Pharmacology

PHARMACOECONOMICS

1170-7690 → ACNP

14

6

1998

639 - 652

ISI

1170-7690(199812)14:6<639:TUACOH>2.0.ZU;2-P

Objective: The aim of the study was to measure the use and estimate the cos t of HIV service provision in England. Design and Setting: Standardised activity and case-severity data were colle cted prospectively in 10 English HIV clinics (5 London and 5 non-London sit es) for the periods 1 January 1996 to 30 June 1996 and 1 July 1996 to 31 De cember 1996 and linked to unit cost data. In total, 5440 patients with HIV infection attended during the first 6 months and 5708 during the second 6 m onths in 1996. Main Outcome Measures and Results: The mean number of inpatient days per pa tient-year for patients with AIDS was 19.7 [95% confidence interval (CI): 1 3.7 to 25.7] for January to June and 20.8 (95% CI: 15.3 to 26.4) for July t o December 1996. The mean number of outpatient visits for asymptomatic pati ents with HIV infection was 14.8 (95% CI: 11.9 to 17.6) and 133 (95% CI: 10 .8 to 15.7) for the respective periods and 16.1 (95% CI: 13.21 to 18.97) an d 15.7 (95% CI: 11.2 to 20.2), respectively, for patients with symptomatic non-AIDS (i.e. symptomatic patients with HIV infection but without AIDS-def ining conditions). Substantial centre-to-centre variation was observed, sug gesting that many clinics can continue the shift from an inpatient- to an o utpatient-based service. Cost estimates per patient-year for HIV service pr ovision for 1996 varied from pound 4695 (95% CI: pound 3769 to pound 5648) for asymptomatic patients, to pound 7605 (95% CI: pound 6273 to pound 8909) for symptomatic non-AIDS patients to pound 20 358 (95% CI: pound 17 681 to pound 23 206) for patients with AIDS. Conclusions: Different combinations of antiretroviral therapy affect the co st estimates of HIV service provision differently. Anticipated reduction in inpatient-related activity through the increased use of combination antire troviral therapy will further shift service provision from an inpatient- to outpatient-based service and reduce costs per patient-year. The extent and duration of such effects are currently unknown. The long term effects of c ombination treatment on the morbidity and mortality patterns of individuals infected with HIV are also currently unknown, as are their implications on the use and cost of HIV service provision. Multicentre databases like the National Prospective Monitoring System (NPMS) will provide healthcare profe ssionals with information to improve existing services and anticipate the i mpact of new developments.