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1994-08-20
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Document 0639
DOCN M9480639
TI Changing use of hospital services and costs at a London AIDS referral
centre, 1983-1989.
DT 9410
AU Beck EJ; Kennelly J; McKevitt C; Whitaker L; 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):367-77. Unique Identifier : AIDSLINE MED/94304559
AB OBJECTIVE: To describe the use of hospital-based services and associated
costs over time for HIV-infected individuals by disease stage and year
of treatment. METHODS: Data on service use were abstracted from
inpatient and outpatient case-notes of 459 HIV-infected patients (121
asymptomatic and 338 AIDS patients) treated at St Mary's Hospital,
London between 1983 and 1989. Cost estimates were derived from a survey
of the 37 departments involved with HIV-related care. The number and
type of admissions and outpatient visits, referral and discharge venues,
number and type of tests and procedures performed, drugs prescribed and
associated costs for the study period were the outcome measures used.
RESULTS: Most patients were homosexual men. At the time of first
HIV-related visit, 80.7% lived in London. Most day cases and planned
admissions were organized through the outpatient clinic; 31% of
emergency admissions were initiated by patients themselves. For people
with AIDS the number of day case admissions increased while planned
admissions decreased. There was a marked reduction in the duration of
inpatient stays, especially for AIDS patients. Costs associated with
inpatient care decreased concomitantly. The number of outpatient visits
for patients with symptomatic disease increased, resulting in increased
outpatient expenditure. Asymptomatic patients had fewer inpatient tests,
while outpatient tests did not change over time; costs followed similar
patterns. Mean inpatient and outpatient drug-days prescribed did not
change nor did average inpatient drug-costs although outpatient
drug-costs increased. Inpatient tests performed on symptomatic non-AIDS
patients decreased, while mean outpatient tests increased; average costs
followed similar patterns. Inpatient drug-days prescribed and costs
remained the same, while outpatient drug-days and average drug-costs
increased during the study period. For AIDS patients, the number of
inpatient tests performed and their average costs decreased but
outpatient tests performed increased, though their average costs
remained the same. Mean inpatient drug-days prescribed and average
drug-costs decreased, while number of outpatient drug-days prescribed
and average drug-costs increased markedly over time. For each disease
category, expenditure on admissions and related tests decreased over
time, while expenditure on outpatient visits and drug-costs increased.
CONCLUSIONS: The shift from an inpatient- to an outpatient-based service
has resulted in fewer patients being investigated and treated in
hospital and more as outpatients. This has resulted in a reduction of
inpatient-related costs, while outpatient-related costs have increased.
The overall contribution of drug-costs to the total cost has increased
greatly over time. With the anticipated advent of new antiviral
compounds, the importance of ascertaining their effectiveness as well as
their efficacy will become crucial.
DE Acquired Immunodeficiency Syndrome/*ECONOMICS/THERAPY Adult Ambulatory
Care/ECONOMICS/TRENDS Antiviral Agents/ECONOMICS Female Hospital
Costs/*TRENDS Hospitalization/STATISTICS & NUMER DATA/TRENDS
Hospitals, Urban/ECONOMICS/*UTILIZATION Human HIV
Infections/*ECONOMICS/THERAPY London Male Referral and Consultation
Support, Non-U.S. Gov't JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).