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1994-08-20
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Document 0638
DOCN M9480638
TI Changing presentation and survival, service utilization and costs for
AIDS patients: insights from a London referral centre.
DT 9410
AU Beck EJ; Whitaker L; Kennelly J; McKevitt C; Wadsworth J; Miller DL;
Easmon C; Pinching AJ; Harris JR; Academic Department of Public Health,
St Mary's Hospital and; Medical School, London, UK.
SO AIDS. 1994 Mar;8(3):379-84. Unique Identifier : AIDSLINE MED/94304560
AB OBJECTIVE: To describe the use of services and associated costs for
HIV-infected patients by stage of infection in the context of changing
patterns of presentation and survival. METHODS: A retrospective analysis
of inpatient and outpatient case-notes of 335 AIDS patients and a survey
of HIV-related care provided by 37 departments at St Mary's Hospital,
London. Survival from time of diagnosis of AIDS, time from diagnosis of
HIV infection to AIDS, and use and costs of services per patient-year
were outcome measures. RESULTS: During the study period 1 January 1982
to 30 September 1989, 152 AIDS patients were diagnosed before 1987
(group 1) and 183 since 1987 (group 2), most of whom were homosexual
men. The median interval of first HIV-related visit to diagnosis of AIDS
increased from 0 (group 1) to 264 days (group 2; P < 0.0001). Median
survival from AIDS diagnosis increased from 14.6 (group 1) to 21.0
months (group 2; P < 0.02). Group 2 patients used fewer inpatient
services than group 1 patients irrespective of disease stage.
Symptomatic patients in group 2 used more outpatient services than group
1 patients. Total HIV-related expenditure was lower for patients without
AIDS in group 2 than in group 1, while expenditure for AIDS patients
remained similar. CONCLUSION: Earlier patient presentation, a shift from
inpatient- to outpatient-based clinical care and increased survival from
time of AIDS diagnosis has occurred. Increased drug expenditure was
offset by reduced inpatient expenditure. Total expenditure per
patient-year was stable; increased survival and introduction of new
drugs will increase future lifetime use of resources.
DE Acquired Immunodeficiency Syndrome/*ECONOMICS/*MORTALITY/THERAPY Adult
Ambulatory Care/ECONOMICS/TRENDS/UTILIZATION Female Hospital
Costs/*TRENDS Hospitalization/ECONOMICS/STATISTICS & NUMER DATA/TRENDS
Hospitals, Urban/ECONOMICS/TRENDS/*UTILIZATION Human
London/EPIDEMIOLOGY Male Referral and Consultation Retrospective
Studies Support, Non-U.S. Gov't Survival Analysis JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).