Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Tu.D.251 -Tu.D.254

Tuesday, July 9, 1996

Indirect cost included loss of income due to illness and premature death and loss of productivity from disability. Costs presented were actual cost values and not hospital charges.
Results: A total of 95 patients' records were reviewed. Of these, 54 (57%) were interviewed. Majority of the patients were entertainers 29 (70%), followed by professionals 21
(40%) and service workers I/7 (33%).Their mean age at diagnosis was 32 years.The mean
number of outpatient visits was 4 times per patient per year with the mean of 3 admissions
per AID)S patient.The medical care cost per case of an asymptomatic patient during the first
year of diagnosis was US$301. Durng the early symptomatic stage, the cost per case per
year was US$830 and in the late symptomatic stage, it was US$5,774. Of the 54 patients
interiewed, 18 (33%) lost employment immediately after diagnosis, 15 (28%) changed
occupation while 15 (28%) quit their job only at full blown AIDS.The rest remained unemployed.The indirect cost attributable to illness or disability and premature death was
US$324,653.56 per patient. Thee overall lifetime direct and indirect cost of HIV infection
was US$332,5 30.3.
Conclusion: -The mediodl care costs of AIDS were more than the average per capita
income of the averayge Filipino household. Since there was very limited insurance coverage,
medial care costs were ether borne by the government or the household. Results of this
study can be urtilzed by policy makers and program managers in planning resource allocation, awareness raising and targetn r interventions to curtail the spread the epidemic in the
Phihlppines.
M.RA.Aplas ca, Researc Institute for Tropical Medicine, Alabang, Muntnlupa City 1702
Philippoes.Tol.: 842-28-28 842-20-79: 8422 I-94 Fax: [phone]
email: mraplascahealthnet.phl.org
Tu.D.25 I
THE COMPARATIVE COST OF PHARMACEUTICALS IN HIV MANAGEMENT
GIl,.rohn, WeberM. Davidson, W., McDonal d, J. University of Calgary Calgary, Alberta
Objectives: To determine the cIrect medical costs of treating HIV infection in a stable
regional popuaton recern care throuh a centralized outpatient program, and describe
the impl ications for future HIV care.
Methods: We haKso calculated average monthly direct medical costs for all of the 452
patients seen during a ten month period (02/95- I /95). Costs per patient have been
grouped by cost category and CD4 count. Community care costs are currently being evaluated, and have been excluded.
Results:
Average Monthly Costs per Patient (in Canadian $)
CD4 Pharmaceuticals Hospital Lab Costs Clinic Care Totals
> 500 82 13 54 26 175
200 500 155 1 33 98 43 429
100 200 352 135 88 50 625
< 100 647 224 62 77 1010
Antiretrovral therapy accounts for /7% of average monthly drug costs for persons with a
CD4 count of greater than 200/mm T, but falls to 19% for persons with a CD4 count <
100/rrrm3. Suppression or prophylaxis argainst infection accounts for 12% of average monthly drug costs for persons with a CD4 count of greater than 200/mm3, but rises to 72%
wher CD4 count falls below I00/mm3.
Conclusions: Average drug costs per patient far exceed other average medical costs. With
acuity levels ncreasing (patients with a CD4 count < 100/mm3 have increased six-fold over
the last 7 years), a profound effect on drug budgets despite the effective provision of outpatient programs and reduced hospitalizations is to be anticipated.
M. Jonn Gll, Southern Alberta Clin ic, 1403-29th Street NW, Calgary, Alberta T2N 2T9
Phone: [phone]; Fax: [phone]; Email: jgilowacs.ucalgaryca
Tu.D.252
A STANDARDISED COSTING FRAMEWORK FOR HIV/AIDS HOSPITAL CARE IN
THE EUROPEAN UNION
Tolley K."GyldIrs,!., Postma, M., Jaer J.,*University of Nottingham, Notti ngham, UK;
KaDanish Hospita Institute, Copenhagen, Denmar k;, '"National Institute of Public Health
and Environmental Protecti on, Bilthoven, the Netherlands
Objective: c develop a standardized famework forimproved quality and comparability in
the esmation of the costs of HIV/AIDS hospital treatment and care in the European
Unioq ([U) (EU Project 'Managin r the costs of HIV infection" SOC94 200180 05F01, in
col laboration with an EU Concerted Action on "HIV/AIDS Multinational Scenario Analysis"
BMH I CT 941723).
Methods: Workshops and other input from an international project steering group, a review
of recent Europea n H IV/AIDS hospital costs literature, a review of national kHIV/AIDS
resource use databases in the EU and discussions with national planners.
Results: A preliminary Standardized Hospital Costing Framework (SHCF) for HIV/AIDS has
been develoaped.h31ree sets of standards have been defined: required, desired and optional,
app led to each of 5 components of hospital costing: identiication of cost components,
measurement of resourc se units, methods of data collection according to HIV/AIDS
stae categorization, methods of resource unit cost estmation, and the analysis/presentation
of cost data.The overlyity srandard principle in the SHCF is that cost estimation should be
patientbased (ie. bottom up)
Conclusion: Ihe SHCF has been designed for the following intra- and international (EU
level) applications: financa planning and public policy investigation of cost variations, detailed
cost snalysis, resource use data pooling across stes, cost proectons and impact scenarsos.
and corrpason with the costs of treatment and care for other diseases.The famework
offers the possibSity of wider cross disease cost comparisons in the EU and potentially in
other regions
K.Tol ey Department of Public kealth Medicine and Epidemiology Queen's Medical Centre,
[Jr orsity of Nottingham, NottInpham NG72UH, UK.Tel: [phone] x4464 I
Fax: + 115 970 9316 E-mail: sphsotinham.ac.uk

Tu.D.253
ECONOMIC IMPACT ASSESSMENT OF AIDS IN THE EU; UPDATED SCENARIOS ON
HOSPITAL CARE FOR THE YEAR 2000
Postma, Maarten *, Leidl RM**,Tolley K* *, Jager JC*, European Research Team on AIDS
Scenarios.; * National Institute of Public Health and Environmental Protection, Brithove, the
Netherlands; ** University of Limburg, Maastricht, the Netherlands; * i erso
Nottingham, Nottingham, UK
Objective:To project the need for hospital resources for AIDS patients in the Europea
Union (EU) in the year 2000, using multinational scenario analysis (EU Conerted Acto
BMH I-CT941723).
Data: In collaboration with the EU-funded project "Managing the Costs of HIV Ifcton"
(EU Project numoer SOC94-200180-05F01),national European studies on t utlization o
hospital care for AIDS have been selected.The selection criteria involve recentness. quait,
comparability accessibility and representativeness. Baseline hospital resource utlizion
estimated for hospital inpatient days, outpatient visits and day care days, us ng. standard
ized approach which takes into account the case mix for different levels o severt.
Methods: The scenario construction involves the use of standard mode ls of epidemolog,, al
estimation and projection, in particular back-calculating HIV incidence and proeco1; AIDS
incidence, prevalence and mortaltyTo complete the scenarios, baseline reso.ii ce utlzit;on
is linked to epidemological information, to project the future need for hosptal resoces
the EU.The reference scenorio shows future hospital resource needs assuming no mar
changes in epidemiology, treatment and care.Two Slterr110 05scenario sow the 0ipact on
hospital care of introducing AIDS therapy and of i major investment in HIV prevention.
Results: Application of the selection criteria show a lack of studies on hospital resource utilization in several European countries. Scenarios indicate hospital bed needs o 5,800 to
7,400 in the EU in the year 2000, an increase of 30-70% compared to so estrrte I cr
rent (1995) level The growth in the number of hospital ambulatory contats oupitent
visits and day care days) is projected to exeed that o fnpatient days.
Conclusions: Ignoring the case mix for different levels of severity underesoinates the futre
hospital resource needs in several scenarios. Projected hospital resources for AIDS patients
in the EU in 2000 show a maximum bed need of 0.35% of all hospital beds in the EU and
ambulatory contacts possibly surpassing one million.
MJ Postma, PO Box I, 3720 BA Bilthoven, the Netherlands Telephone: 31 30 - 2846
Fax: [phone], email: Maarten.Postmasrivm.nl
Tu.D.254
REDUCED HOSPITALIZATION COSTS AND IMPROVED QUALITY OF LIFE FOR
PEOPLE LIVING WITH HIV VIA COMPUTER-BASED SUPPORT
Boberg, Eric W, Gustafson DH, Hawkins RP Brncker E, Graziano FM. University of sy isconsn,
Madison, WI, USA
Objective: To determine the effects on health care costs and quality of Iife of an home,
computer based system providing information, referrals, skills training, dea son andso;L
support to people living with HIV
Methods: Two hundred and four men and women from southern Wisconsin, it,I stages of
HIV infection, were randomly assigned to receive either no intervention or in-home nstaltion and access to the computer based support system for three to six months. All subjects
completed self report surveys, before, during and after the ntervention, on qualty of Ife,
sexual risk taking behaviors, and frequency and duration of use of health care services 90
of subjects completed the study
Results: Subjects given the computer system (96 male. 20 female) used it extene, r
average of one use per subject per day for an average total use dunny the study o over 39
hours.The system was used heavily by all segments of the population, 'ciud.' 'om 'and
minorities. Subjects using the computer system, compared with untreated coros, reported: I) significant improvements in several dimensions of qualit of Ife ((yrognite functoning,
social support, sociala activity partic ipation in health care, and negat ve emot ons) 2) reduced
time spent in ambulatory care sits; and, 3) significantly sh orter hospit zitions. Estimated
sangs in hospitalization costs were over 35%. Continuedd K ospis v ito sadnns wr r'e
observed even after the computers were removed. No effeCts of the ster were
observed in sexual risk-taking behaviors. Estimated hardw5e/personnel costs of providinp
the system to patients for 6 months is approximately $500
Conclusions: This is the first study to demonstrate significant improve ents n quality of
life and reduced health care costs through use of an in-home co put, r based sIn ppot
system.The costs of providing the system are sigificantly less than the potentialcc,iLma p r
hospitalization costs.
Eric W. Boberg, 1122 WARF Building, 610 Walnut St., Madison,WI 53 S705 Tel.: 08 2 878:
Fax: [phone]; e mail: [email protected]

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