Abstract
This paper compares AIDS hospital care in several European‐Union countries. For this purpose hospital‐care utilisation studies on inpatient days and outpatient contacts were analysed in a generic approach controlling for severity stages of AIDS. Lifetime hospital‐care needs for AIDS are derived, providing useful information for health‐care policy makers.
In a next step, lifetime estimates are linked to estimated annual new cases of AIDS, resulting from standardised epidemiological modelling. These results on AIDS impact at the population level are reported including statistical confidence limits. Both lifetime hospital‐care needs at the patient level and AIDS impact at the population level are compared between countries and related to characteristics of the national AIDS epidemics and health‐care systems.
A person with AIDS has a contact – either inpatient day or outpatient visit – with the hospital in 14% (UK) to 24% (France) of the days spent in the AIDS stage. Related to the national AIDS epidemics (epidemiological impact), Italy and Greece have high levels of outpatient contacts per million population. Estimated hospital‐bed needs for AIDS in 1995 are up to 2.13% (in Spain) of total national acute‐care hospital beds available. Estimated per‐capita needs for outpatient visits in 1995 are highest in Italy, corresponding to 108 doctor full‐time equivalents. In a case‐study for Greece and The Netherlands, differences in hospital‐care utilisation patterns were assessed to correspond with differences in their health‐care systems (number of hospital beds, doctors and nurses per capita and some qualitative characteristics of medical care in both countries).
International comparison of AIDS hospital care is possible using standardised analysis of national hospital‐care utilisation data and standardised epidemiological modelling. Estimates of lifetime hospital‐care needs are an essential input for cost‐effectiveness analyses used to aid health‐care policy decision‐making.
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M.J. Postma, R. Leidl, A.M. Downs, J. Rovira, K. Tolley, M. Gyldmark and J.C. Jager, Economic impact of the AIDS epidemic in the European Community: towards multi-national scenarios on hospital care and costs, AIDS 7 (1993) 541–553.
J.C. Jager, M.J. Postma, K. Tolley and J. Kennelly, Assessment of the socio-economic impact of AIDS: from national towards multinational scenarios, in: The Economic and Social Impact of AIDS in Europe, eds. D. Fitzsimons, V. Hardy and K. Tolley (Cassell, London, 1995) pp. 240–53.
J.C. Jager, P.A. Achterberg, M.J. Postma and H. Houweling, Comparative impact assessment of AIDS; between doomsday and complacency, AIDS 10 (1996) 238–240.
K. Tolley and M. Gyldmark, The treatment and care costs of people with HIV infection and AIDS; development of a standardized framework for Europe, Health Policy 24 (1993) 55–70.
K. Tolley and M. Gyldmark, A Standardized Costing Framework for HIV/AIDS Hospital Care in the European Union (University of Nottingham, Nottingham, 1995).
K. Tolley and M. Gyldmark, Towards a standardized framework for costing HIV and AIDS treatment and care in Europe, in: The Economic and Social Impact of AIDS in Europe, eds. D. Fitzsimons, V. Hardy and K. Tolley (Cassell, London, 1995) pp. 25–39.
K. Tolley, M.J. Postma, J.C. Jager and M. Good, A standardized costing framework for HIV/AIDS hospital care in the European Union, in: AIDS Cost Analysis and Patient Classification, eds. J. Kyriopoulos, H. Kornarou, V. Paparizos and M. Gitona (Exandas, Athens, 1998) pp. 37–52.
R. Brookmeyer and J. Liao, Statistical modelling of the AIDS epidemic for forecasting health-care needs, Biometrics 46 (1990) 1151–1163.
J.C. Jager, S.H. Heisterkamp and R. Brookmeyer, AIDS surveillance and prediction of the HIV and AIDS epidemic: methodological developments, AIDS 7 (1993) S67–S71.
M.J. Postma et al., Hospital care for persons with AIDS in the European Union, Health Policy 41 (1997) 157–176.
M.J. Postma, H. Kornarou, V. Paparizos, R. Leidl, K. Tolley, J. Kyriopoulos and J.C. Jager for the European Research Team on AIDS Scenarios, Hospital care for patients with AIDS in Greece and The Netherlands; assessment of current and future impact, in: AIDS Cost Analysis and Patient Classification, eds. J. Kyriopoulos, H. Kornarou, V. Paparizos and M. Gitona (Exandas, Athens, 1998) pp. 69–88.
J.C. Jager and E.J. Ruitenberg, Statistical Analysis and Mathematical Modelling of AIDS (Oxford University Press, Oxford, 1988).
European Centre for the Epidemiological Modelling of AIDS, Back-calculated estimates of HIV cumulative incidence and prevalence to December 31st 1993 and predicted annual numbers of AIDS cases to 1998 among adults and adolescents, AIDS Surveillance in the European Community and COST-countries 32 (1994).
P.J. Bindels, M.J.J.C. Poos, J.Th.L. Jong, J.W. Mulder, J.C. Jager and R.A. Coutinho, Trends in mortality among AIDS patients in Amsterdam 1982-1988, AIDS 5 (1991) 853–858.
M.G.W. Dijkgraaf, Utilization of Hospital Resources and the Costs related to HIV Infection (Thesis Publishers, Amsterdam, 1995).
A.M. Johnson, C. Shergold, A. Hawkins, R. Miller and M.W. Adler, Patterns of hospital care for patients with HIV infection and AIDS, J. Epidemiol. Community Health 46 (1993) 232–237.
Y-A. Flori and E. Bauchet, Prospective SIDA 2010; Projet de Base d'Analyse (Centre de Recherches en Economie de la Santé, INSERM Unité 357, Paris, 1995).
Y.-A. Flori, M. Kerkleau and M. Le Vaillant, Analyse de l'Hétérogénéité des Practiques Médicales dans la Prise en Charge des Malades Infectés par le VIH; Une Méthode Centrée sur le DMI2 (Centre de Recherches en Economie de la Santé, INSERM Unité 357, Paris, 1994).
J. Kyriopoulos, H. Kornarou, M. Gitona and V. Paparizos, Estimates of HIV/AIDS healthcare expenditure in Greece: an analytic approach for prospective financing, in: The Economic and Social Impact of AIDS in Europe, eds. D. Fitzsimons, V. Hardy and K. Tolley (Cassell, London, 1995) pp. 54–62.
G. Papaevangelou, H. Kornarou, A. Roumeliotou and J. Yfantopoulos, An approach to the direct and indirect cost of AIDS in Greece, in: The Economic and Social Impact of AIDS in Europe, eds. D. Fitzsimons, V. Hardy and K. Tolley (Cassell, London, 1995) pp. 63–73.
A. Tramarin, F. Milocchi, K. Tolley, A. Vaglia, F. Marcolini, V. Manfrin and F. De Lalla, An economic evaluation of home-care assistance for AIDS patients; a pilot study in a town in Northern Italy, AIDS 6 (1992) 1377–83.
A. Tramarin, K. Tolley, S. Campostrini and F. De Lalla for the Italian Group on Study of Alternative Care for AIDS patients, The application of the balance of care model to a National AIDS Health Plan, AIDS 11 (1997) 809–816.
M.J. Postma, J.C. Jager, M.G.W. Dijkgraaf, J.C.C. Borleffs, K. Tolley and R.M. Leidl, AIDS scenarios for the Netherlands; the economic impact on hospitals, Health Policy 31 (1995) 127–150.
J. Rovira, G. Lopez, A. Roman, M. Santin and X. Badia, Els costos de l'assisténcia sanitaria als malats infectats per VIH i la SIDA; una aproximacio empirica (Health care costs of HIV and AIDS patients; an empirical approach; in Spanish), Salut Catalonya 6 (1992) 139–144.
E.J. Beck, J. Kennelly, C. McKevitt, L. Whitaker, J. Wadsworth, D.L. Miller, C. Easmon, A.J. Pinching and J.R.W. Harris, Changing use of hospital services and costs at a London AIDS Referral Centre, 1983-1989, AIDS 8 (1994) 367–377.
E.J. Beck, The cost of hospital care for HIV infected patients; the impact of changing survival patterns and use of services in London in the 1980s, in: The Economic and Social Impact of AIDS M.J. Postma et al. / Hospital care for persons with AIDS in European-Union countries 7 in Europe, eds. D. Fitzsimons, V. Hardy and K. Tolley (Cassell, London, 1995) pp. 90–98.
F.J. Hellinger, J.A. Fleishman and D.C. Hsia, AIDS treatment costs during the last months of life: evidence from the ACSUS, Health Services Research 29 (1994) 569–581.
J.A. Fleishman, V. Mor and L.L. Laliberte, Longitudinal patterns of medical service use and costs among people with AIDS, Health Services Research 3 (1995) 403–424.
C.L. Bennett, D.P. Lubeck, D.J. McShane, J.K. Mathews and W.H. Lipil, Costs of terminal care for people with AIDS, AIDS Patient Care 2 (1995) 7–9.
M.J. Postma, J.C. Jager, D. Ruwaard, N.C.M. van Loy and R.M. Leidl, Disease-staging for modelling current and future health-care impact of disease; illustations for diabetes mellitus and AIDS, Health Policy 43 (1998) 45–54.
N.S. Hartunian, C.N. Smart and M.S. Thompson, The Incidence and Costs of Major Health Impairments (Lexington Books, Toronto, 1981).
Drummond, B.J. O'Brien, G.L. Stoddart and G.W. Torrance, Methods for the Economic Evaluation of Health Care Programmes (Oxford University Press, Oxford, 1997).
EUROSTAT, EUROSTAT Jaarboek '95 (Bureau voor Officiële Publikaties der Europese Gemeenschappen, Luxemburg, 1995).
M. Schneider, R.K.-H. Dennerlein, A. Kose and L. Scholtes, Health Care in the EC Member States, Health Policy 20(special issue) (1992).
E. Tragakes and N. Polyzos, Health-Care Systems in Transition; Greece (WHO, Copenhagen, 1996).
OECD, The Reform of Health-Care Systems; A Review of Seventeen OECD-Countries (OECD, Paris, 1994).
C. Politis and J. Yfantopoulos, Blood Transfusion and the Challenge of AIDS in Greece; Medical and Economic Aspects (Beta Medical Publishers, Athens, 1993).
C. Spreeuwenberg and A.J.P. Schrijvers, Health care in Europe, in: Oxford Textbook of Public Health; Vol. 1. Influences of Public Health, eds. W.W. Holland, R. Detels and G. Knox (Oxford University Press, New York, 1991).
OECD, OECD Health Systems; Facts and Trends 1960-1991 (OECD, Paris, 1993).
Statistics Netherlands, Costs and Financing of Health Care;1972- 1992 (SDU, The Hague, 1994).
G. Lueschen, W. Cockerham, J. van der Zee, F. Stevens, J. Diederiks, M. Garcia Ferrando, A. D'Houtaud, R. Peeters, T. Abel and S. Niemann, Health Systems in the European Union; Diversity, Convergence and Integration (R. Oldenbourg, München, 1995).
M. McCarthy and S. Rees, Health Systems and Public Health Medicine in the European Community (Royal College of Physicians, London, 1992).
E. Mossialos and A. Karokis, Greece; Health-care reforms, Lancet 340 (1992) 41–42.
A. Sissouras, Backgrounds and developments in health care in Greece, in: Competitive Health Care in Europe; Future Prospects, ed. A.F. Casparie (Dartmouth, 1990).
J. Kyriopoulos and D. Niakas, Economic and health policy issues in biomedical technology; the case of Greece, in: Strategic Issues in Health-Care Management, eds. M. Malek, J. Rasquinha and P. Vacani (Wiley, Chichester, 1993).
OECD, Health Data Database (OECD, Paris, 1995).
K. Tolley, A. Ghani, J. Kennelly, C. Lee, A.M. Tramarin and F. De Lalla, Comparing the costs of HIV/AIDS treatment and care: examining the relationship between diagnostic stages and costs, in: Proceedings of the International Conference on the Econometrics of AIDS (University of Barcelona, Barcelona, 1993) pp. 91–106.
D. Niakas and J. Kyriopoulos, Methodological problems in cost estimations of AIDS in Greece and a framework for cost measurement, in: AIDS Economics; Cost Analysis, Management and Prospective Financing, eds. J. Kyriopoulos, H. Kornarou and M. Gitona (Exandas, Athens, 1996) pp. 113–131.
M.J. Postma, J. van Bergen and J.C. Jager, Pharmaco-economic evaluation of anti-retrovirals in treatment and prevention of HIV/AIDS, in: Proceedings of the 12th World AIDS Conf., Part II (Clinical Science), Geneva, 1998 (Monduzzi editore S.p.A., Bologna, Italy, 1998) pp. 381–385.
M.J. Postma, The role of pharmaco-economics in HIV control, in: Proceedings of the Conf. on AIDS e Sindromi Correlati (Genua, 1998) p. 46.
M.J. Postma, E.J. Beck, R.M. Leidl, K. Tolley and J.C. Jager, Estimated future economic impact of HIV/AIDS in the European Union; study for the EU Concerted Action on multi-national AIDS scenarios, in: Abstract Book of the 12th World AIDS Conf., Geneva, 1998, abstract 43488.
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Postma, M.J., Kornarou, H., Paparizos, V. et al. Hospital care for p ersons with AIDS in European‐Union countries; a cross‐country comparison. Health Care Management Science 3, 1–7 (2000). https://doi.org/10.1023/A:1019064518010
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DOI: https://doi.org/10.1023/A:1019064518010