© 1996 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
research-article |
The use and cost of hospital services by London AIDS patients with different AIDS defining conditions
Eduard J. Beck, Senior Research Fellow in Epidemiology1,*
Emil J. Kupek, Research Associate in Statistics1
Jane Wadsworth, Senior Lecturer in Statistics1
David L. Miller, Professor in Public Health Medicine11
Anthony J. Pinching, Professor in Immunology2
John R. W. Harris, consultant Physician in Genitourinary Medicine2
1Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, Norfolk Place, London W2 1PG
2Department of Immunology, Medical College of St Bartholomew's Hospital London
3Department of Genitourinary Medicine, St Mary's Hospital and Medical School London
Address correspondence to Dr E. J. Beck
BACKGROUND: Contracting for HIV service provision is now an established part of the National Health Service commissioning process. AIDS is a heterogeneous condition, comprising various opportunistic illnesses which require different services and which have different resource implications. This study describes the use of hospital services and associated costs for the management of different AIDS defining conditions.
METHOD: A retrospective case-notes analysis was performed, of 335 AIDS patients treated at St Mary's Hospital, London, between 1 January 1983 and 30 September 1989, as well as a costing exercise of 37 clinical departments to calculate HIV-related costs.
RESULTS: Mean age at time of AIDS diagnosis for these predominantly homosexual men was 38 years. Use of services varied, as did associated costs – from £8163 per patient-year for patients with Constitutional Disease to £42124 for those with Cytomegalovirus Disease. Most diagnostic categories showed a shift over the study period from an in-patient- to an out-patient-based service.Patients diagnosed after 1987 had overall lower costs perpatient-year compared with those diagnosed before 1987; whereas out-patient costs for most groups had increased, in-patient expenditure decreased. For most categories, in-patient care costs and out-patient drugs prescribed provided the greatest proportion of total costs. Average costs per in-patient day ranged from £334 to £433, and average costs per out-patient visit ranged from £99 to £411 for different AIDS defining conditions.
CONCLUSIONS: Different opportunistic illnesses of symptomatic HIV disease have different treatment and resource implications. Casemix will need to be taken into consideration when contracting for HIV services, including extra-contractual referrals.
Keywords: AIDS, casemix, service provision, costs