Hospital Service Utilization by HIV/AIDS Patients and Their Management Cost in a Provincial Genitourinary Medicine Department

Abstract

Summary: The hospital management of 108 HIV/AIDS patients cared for by the genitourinary medicine department, Sheffield, UK between 1984–93 was retrospectively studied to quantify the services utilized by these patients and to detail the management costs (1993 price) of outpatient (OP) services, inpatient (IP) care, investigational services and therapeutic provisions. The services utilized and cost are presented separately for the different clinical stages of the infection and as per patient year. Of the 108 patients, 95 (88%) were males and 13 (12%) females; most males (76.8%) acquired the infection through homosexual exposure, while 46% of females acquired it heterosexually. The mean number of OP consultation per asymptomatic, symptomatic non-AIDS and AIDS patient years were 11.6, 16.4 and 32.8 respectively; the mean number of IP episodes for each of these clinical groups were 0.15, 0.83 and 3.88 with IP stays 0.7, 3.5 and 40.6 days per patient year respectively. The annual costs of OP care (£45.26 per consultation), drugs and investigations were, respectively £525, £213 and £153 per asymptomatic patient year, £742, £2097 and £224 per symptomatic non-AIDS patient year and £1485, £2928 and £382 per AIDS patient year. The average annual OP drug cost per patient year showed little change since 1988, However, in the AIDS group, contributions from differing drug classes showed significant changes; while the contribution of antiretroviral drugs fell from 80.2% of the drug cost per AIDS patient year in 1990 to 31.3% in 1993, that from antibiotics rose from 0.3% in 1990 to 26.4% in 1993 and other antivirals from 9.4% in 1988 to 22.6% in 1993. These changes were related to lower recommended daily dosage of zidovudine and to wider prescription of antibiotics for atypical mycobacterial infections and domiciliary gancyclovir for CMV infection. The costs of annual mean IP care, IP drugs, IP investigations and IP procedures per AIDS patient year were £5926 (£146 per IP stay), £2983, £282 and £145 respectively. The overall management cost of one AIDS patient year was £14 131 and lifetime AIDS management cost, based on a mean survival of 17 months, a little more than £20 000. The annual management cost of an asymptomatic and symptomatic non-AIDS patient year is approximately 1/14th and 1/4th of the cost of an AIDS patient year.