Final Program and Oral Abstracts [International Conference on AIDS (8th: 1992: Amsterdam, Netherlands)]

WEDNESDAY, 22 JULY 1992

WeC 1034-WeC 1038

W eC 10 34 NTERACTION AIDS RESEARCH AND PUBLIC
HEALTH PLANNING
de Bruiin. Els.*;van den Boom, F.M.L.G.*; Jager, J.C. ***; Ruitenberg, EJ.***;* Steering
Committee on Future Health Scenaruios, RijswijkNL**Nethedands Inst. of Mental Health, Utremcht,NL***
Nat.Int. of Public Health and Eavironmental Protection, Bilthoven, NL,**** Centr. Lab.of the Netherlands Red
Cross Blood Transfusion Service, Amsterdam,NL
Objective: Apply research findings of HIV/AIDS-scenarios to long-term public health planning.
Methods: The Steering Committee on Future Health Scenarios (STG) in the Netherlands is set up to create public
health scenarios in order to support long-term public health planning. The STG-project "National scenarios
concerning epidemiological sociocultural and economic impacts of HIV/AIDSin society" has been carried out by a
group of AIDS experts in different disciplines (epidemiology, sociology, economy, biomedicine, ethics, law, public
and mental health) supported by an interdisciplinary research team. STG arranges permanent close coordination
between experts, researchers and policymakers. The following scenarios are developed:
- The reference scenario describes the most probable future image of the HIV/AIDS epidemic in the
Netherlands up to the year 2000. It is based on constant trends in epidemiological development of HIV/AIDS
and describes the possible sociocultural and economic consequences thereof.
Alternative scenarios are devised by varying selected key parameters in the epidemiological, sociocultural and
economic fields.
Strateic scenarios are developed on AIDS control and care in a way that a "Self-determination scenario"
opposes a "Detection scenario", and a "Regular care scenario" opposes an "AIDS-specific care scenario".
Results: The AIDS-scenarios offer insight into a wide range of possible future developments of the HIV/AIDS
epidemic, the effects on health care, the costs involved and the influence of risky behaviour( sexual and intra venous
drugs). Several background documents present the state of the art in the relevant research fields. Based on the
scenarios and consensus-building meetings, STG offers recommendations to policymakers on prevention, seroprevalence research, organisation of care, etc..
These recommendations have been largely followed in the official policy document on AIDS recently brought out by
the Dutch Ministry of Welfare, Health and Cultural Affairs. The information and views presented in the AIDSscenarios formed an important base for this document.
Conclusion. Scenario research and the procedure as carried out by STG appears to be a useful tool for the design of
long range public health stategies in the field of AIDS control and care.
E.M. de Bruijn, M.D.; STG/WVC room Br. BCB 371; P.O. Box 3008;
2280 MK Rijswijk; The Netherlands; tel.[phone]; Fax.[phone]
WeC 1036 DYNAMICS OF CHANGE IN THE HIV
PATIENT POPULATION AND HOSPITAL CARE FOR HIV-INFECTED PATIENTS:
1988-1989. Andrulis, Dennis P.; Weslowski, V.; Hintz, E.; Spolarich, A.; Rathbun, J.,
National Public Health and Hospital Institute, Washington, D.C., USA.
Obiectives: To compare, document and analyze hospital care for inpatients meeting the
Centers for Disease Control (CDC) AIDS definition and other HIV-infected individuals not meeting these criteria, who
were treated in U.S. hospitals during 1988 and 1989.
Methods: Hospitals from four national associations, representing over 1100 acute care institutions (189% of all U.S.
acute care hospitals) voluntarily participated in a comprehennive, ongoing national survey for both study years. Total
response rates for both years were 60%. Analyses using primarily paired t-tests and Chi-Square focused on the
following survey-based variables: number of distinct AIDS and HIV patients treated; utilization chracteristics (length of
stay, days/patient/year; admissions/year; mode of exposure; demographic characteristics; source of payment and other
financial information. The two patient groups and the total burden of care (AIDS+HIV patients) were calculated and
compared over the study years.
Results: Hospitals reported AIDS and "other HIV" information on a total of 27,290 AIDS and HIV patients in 1988 and
29,141 in 1989. Declines occurred in the average number of patients treated (from 50 to 42/hospital for AIDS patients
and from 34 to 32/hospital for OHIV patients), and in average length of stay for both groups (from 16.4 to 15.1 for
AIDS patients and from 14.4 to 13.5 for HIV patients). Small increases occurred for homosexual drug users for both
populations while other groups demonstrated marginal changes. Proportions of women remained within a percentage
point (17% in 1988 and 16% in 1989 for total burden [AIDS +HIV]). The Caucasian populations of AIDS and Other
HIV patients increased slightly while Hispanic AIDS patients and Black Other HIV patients declined slightly. Analysis
of sources of payment between the study years indicated decreases in private institutions for AIDS and other HIV
patients of 15% and 259% respectively, with increases spread through public payers for both groups, especially Medicare.
Conclusions: Hospitals appear to be making progress in reducing the number of hospital days of care required for both
AIDS and other HIV patients. The lack of increase in the average number of patients may indicate that a peak has been
reached in the upper limit of patients a hospital can treat (leading to a diffusion of patients to more hospitals) a spread in
the epidemic and more reliance on outpatient facilities. Decrease in private sector support suggests a tightening of
eligibility requirements, while increase in length of survival may allow additional numbers of AIDS and OHIV patients
to claim disability. Implications include larger caseloads for "second tier" cities and hospitals and additional reliance on
public sector support.
Andrulis, Dennis P., National Public Health and Hospital Institute, 1212 New York
Ave, #800, Washington, D.C., 20005, USA, Telephone: [phone], FAX:
(1) 202-408-0235
W eC 1038 THECOSTS AIDSCAREINTHEWORL.D, 1990
Cameron, Charles and Tarantola, Daniel. Global AIDS Policy Coalition, International AIDS
Center, Harvard School of Public Health, Boston, MA, USA.
Pamparam Magazine, Trivandrum, India.
Objective: To estimate the global inpatient and outpatient costs of AIDS care in 1990. To compare this cost with per
capita gross national product (GNP).
Methods: A review of the literature was undertaken to gauge the annual inpatient and outpatient costs per AIDS case.
A survey was conducted in 37 countries which provided government expenditures on care of HIV-infected persons and
those with AIDS. Follow-up with health personnel and researchers in a subset of countries completed the information
collection exercise. In industrialized countries, literature and contacts provided estimates for costs.
In developing countries where cost data existed, costs were extrapolated to the global level by multiplying annual
costs per AIDS patient times the estimated number of AIDS cases per country. Where studies were not available, either
best judgment or, as a surrogate measure, per capita GNP were used for costs. Two scenarios were examined. First, a low
estimate where 70% of AIDS patients in non-OECD countries and 100% in OECD countries received care. A low estimate
for the number of global AIDS cases was used. Second, a high estimate where 100% of all AIDS patients received care. A
high estimate was used for the number of global AIDS cases.
Results: The low scenario shows total costs of $2.6 billion to care for the almost 200,000 persons with AIDS; 70% of whom
in non-OECD countries were assumed to have access to formal medical care. The high cost case shows estimated costs
of $3.5 billion to care for almost 330,000 persons, 100% of whom were assumed to have access to care. While 30-40% of
cases are in OECD countries, they account for 84% to over 90% of all costs. Approximately half of all AIDS cases are in
Africa, yet they represent only between 15% to 2% of global costs.
The cost of treatment for one year for one person ranged from less than US$400 in Africa to between $26,000 and
US$32,000 in OECD countries. Typically, medical care in OECD countries includes AZT. In all countries examined, the
majority of costs were for inpatient care. For example, inpatient care represented 75% and 90% of total annual care costs
in the US and Rwanda, respectively.
It was also concluded that per capita GNP was a reasonable surrogate for annual inpatient and outpatient care costs
for persons with AIDS. Analysis of existing cost studies showed that per capita GNP was a better indicator for developing
than for industrializing countries. For example, in Thailand and Rwanda, annual care costs were estimated at 83% and
112% of per capita GNP, respectively. However, in Switzerland and the US, the ratios were estimated at 122% and 153%,
respectively. In most cases, annual care costs were at least equal to per capita GNP. This supports the use of per capita
GNP for rapidly estimating annual national costs of care for AIDS patients.

WeC 1 035 THE DIRECT COSTS OF HOSPITAL CARE OF AIDS
PATIENTS IN BRAZIL. Esteves, Ricardo*; Huang L.*; Pessoa V.*; Mallet, A.,; Lima
M.5; C6rtes, E.** 'Brazilian AIDS/STD Programme, Ministry of Health, Brasilia;
5Federal University of Rio de Janeiro, Brazil.
OBJECTIVE: To determine direct costs of hospitalization for AIDS patients in Brazil.
METHODS: We did a pilot study involving 127 AIDS patients admitted to three university hospitals, in four
different cities. Medical records were reviewed regarding costs of diagnostics procedures, laboratory tests,
XRays, surgeries, and regular drugs. Costs with personnel and more expensive drugs, like AZT, ganciclovir,
pentamidine, and others, that are provided free by a special drug program of the National AIDS Program, were
not added to the final calculation. In one hospital, costs of AIDS patients were compared to the costs of
internal medicine patients.
RESULTS: The medium daily cost was $331.30. The average hospitalization time was 25.3 days (range 3 -65). If each patient need only one hospitalization per year, it would cost $8,381.89 to provide hospital care for
one year for an patient. In one hospital, the costs of AIDS patients were 1.4 times higher the costs of internal
medicine patients. If each patient needs an average of 25.3 days of hospitalization per year, and spend
$8,381.89 for each admission, and if Brazil have the estimated 90,000 accumulated AIDS cases up to 1995,
it will be necessary to provide a total of 2,277,000 hospital beds, and spend $754,370,100.00 to take care of
all those patients, not including special drugs.
CONCLUSIONS: 1) AIDS epidemic will cause a major economic impact in Brazil; 2) Other studies are
necessary to extend data on costs of AIDS are extremely necessary. A study on AIDS costs, involving over
600 patients, is being conducted by the National AIDS Program, and more data will be available in the near
future.
RICARDO ESTEVES
COORDENA9AO DE DST/AIDS - MINISTERIO DA SAUDE
70058 BRASILIA, D.F., BRAZIL - Fax:[phone]
WeC 1037 PRACTICE GUIDELINES FOR PEDIATRIC HIV
CARE: METHODS OF CALCULATING COSTS
Glied, Sherry*; Sisk, J.E.* *Columbia University School of
Public Health, New York, NY, USA
Objectives: 1) To develop and evaluate a method of calculating the cost implications
of practice guidelines for pediatric HIV care and 2) to compare alternative methods
of estimating the per unit cost of services to pediatric HIV patients.
Methods: From records of 3 New York City hospitals, we abstracted the services provided for 18 months to the first 100 pediatric HIV patients treated in 1990. We
devised a procedure to compare actual care provided to these children, whose HIV
status ranged from PO through P2, to New York State's 1991 guidelines for pediatric
HIV care. For each child, total costs equaled the sum of the number of specific
services times the per unit costs of each service. Alternative methods were used
to calculate per unit cost: hospital's billed' charges, ratio of costs to charges,
and two New York State payment methods.
Results: The guidelines specify elements of history-taking and counseling that,
even if routinely performed, have not traditionally been entered in the medical
record. Compared with central hospital records, records for HIV clinics document
more services provided to specific patients.
Conclusions: Given their incompleteness, central hospital records are likely to
underestimate the services provided to pediatric HIV patients and estimates based on
these records are likely to understate the costs of care. Cost-to-charge ratios
may better approximate economic costs than billed charges, but both are likely to
diverge from actual resources used.
Glied, Sherry, Columbia Un. School of Public Health, 600 West
168th St., New York, NY, USA; telephone: [phone];
FAX: [phone]
NOTES

Charles Cameron, MBA, MPH; International AIDS Center, SPH Bldg. 1 #1208, Harvard School
of Public Health, Boston, MA 02115, USA; tel: [phone]; fax: [phone].

We51