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The Use and Cost of HIV Service Provision in England in 1996

  • Original Research Article
  • HIV Service Provision in England 641
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Abstract

Objective: The aim of the study was to measure the use and estimate the cost of HIV service provision in England.

Design and Setting: Standardised activity and case-severity data were collected prospectively in 10 English HIV clinics (5 London and 5 non-London sites) for the periods 1 January 1996 to 30 June 1996 and 1 July 1996 to 31 December 1996 and linked to unit cost data. In total, 5440 patients with HIV infection attended during the first 6 months and 5708 during the second 6 months in 1996.

Main Outcome Measures and Results: The mean number of inpatient days per patient-year for patients with AIDS was 19.7 [95% confidence interval (CI): 13.7 to 25.7] for January to June and 20.8 (95% CI: 15.3 to 26.4) for July to December 1996. The mean number of outpatient visits for asymptomatic patients with HIV infection was 14.8 (95% CI: 11.9 to 17.6) and 13.3 (95% CI: 10.8 to 15.7) for the respective periods and 16.1 (95% CI: 13.21 to 18.97) and 15.7 (95% CI: 11.2 to 20.2), respectively, for patients with symptomatic non-AIDS (i.e. symptomatic patients with HIV infection but without AIDS-defining conditions). Substantial centre-to-centre variation was observed, suggesting that many clinics can continue the shift from an inpatient- to an outpatient-based service. Cost estimates per patient-year for HIV service provision for 1996 varied from £4695 (95% CI: £3769 to £5648) for asymptomatic patients, to £7605 (95% CI: £6273 to £8909) for symptomatic non-AIDS patients to £20 358 (95% CI: £17 681 to £23 206) for patients with AIDS.

Conclusions: Different combinations of antiretroviral therapy affect the cost estimates of HIV service provision differently. Anticipated reduction in inpatientrelated activity through the increased use of combination antiretroviral therapy will further shift service provision from an inpatient- to outpatient-based service and reduce costs per patient-year. The extent and duration of such effects are currently unknown. The long term effects of combination treatment on the morbidity and mortality patterns of individuals infected with HIV are also currently unknown, as are their implications on the use and cost of HIV service provision. Multicentre databases like the National Prospective Monitoring System (NPMS) will provide healthcare professionals with information to improve existing services and anticipate the impact of new developments.

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References

  1. Beck EJ, Kennelly J, McKevitt C, et al. Changing use of hospitalservices and costs at a London AIDS referral centre1983-1989. AIDS 1994; 8: 367–77

    Article  PubMed  CAS  Google Scholar 

  2. Beck EJ, Whitaker L, Kennelly J, et al. Changing presentationand survival, service utilization and costs for AIDS patients:insights from a London referral centre. AIDS 1994; 8: 379–84

    Article  PubMed  CAS  Google Scholar 

  3. Rees M, Roberts B, Brindle S. AIDS/HIV: the cost of the servicein Riverside D.H.A. London: AIDS Costing Project, Departmentof Health, 1988

    Google Scholar 

  4. Rees M. The cost of AIDS/HIV in the Oxfordshire Health District. London: AIDS Costing Project, Department ofHealth, 1989

    Google Scholar 

  5. Rees M. The cost of AIDS/HIV in the Brighton District. London: AIDS Costing Project, Department of Health, 1989

    Google Scholar 

  6. Johnson AM, Adler MW, Crown JM. The acquired immunedeficiency syndrome and epidemic of infection with humanimmunodeficiency virus cost of care and prevention in aninner London district. BMJ 1986; 293: 489–92

    Article  PubMed  CAS  Google Scholar 

  7. Johnson AM, Shergold C, Hawkins A, et al. Patterns of hospitalcare for patients with HIV infection and AIDS. J Epidemiol Community Health 1993; 47: 232–7

    Article  PubMed  CAS  Google Scholar 

  8. Kennelly JM, Tolley KH, Ghani ACH, et al. Hospital costs oftreating haemophilic patients infected with HIV. AIDS 1995;9: 787–93

    Article  PubMed  CAS  Google Scholar 

  9. Morton A, McCallum A, Parkin D, et al. The cost of caring forpatients with HIV infection and AIDS. Newcastle upon Tyne: Department of Epidemiology and Public Health, Universityof Newcastle upon Tyne, 1994

    Google Scholar 

  10. Nageswaran A, Kinghorn G, Shen R, et al. Hospital serviceutilization by HIV/AIDS patients and their management costin a Provincial Genitourinary Medicine Department. Int JSTD AIDS 1995; 6: 336–44

    CAS  Google Scholar 

  11. Tolley K, Gyldmark M.Towards a standardized framework forcosting HIV and AIDS treatment and care in Europe. In:Fitzsimons D, Hardy V, Tolley K, editors. The economic andsocial impact of AIDS in Europe. London: Cassell, 1995:25–39

    Google Scholar 

  12. Curtis H. Funding implications of combination therapies. J HIV Comb Ther 1997; 2: 27–8

    Google Scholar 

  13. Beck EJ, Glandt M. The National Prospective Monitoring Systemon the Use, Cost and Outcome of HIV Service Provisionin English Hospitals: feasibility report to the NPMS workingparty 1994. London: Academic Department of Public Health,St. Mary’s Hospital Medical School, 1994

    Google Scholar 

  14. Beck EJ. National Prospective Monitoring System on the Use,Cost and Outcome of HIV Service Provision in English Hospitals:summary review and business plan 1997-2001. London: Coordinating and Analytic Centre, Department ofEpidemiology & Public Health, Imperial College School ofMedicine at St. Mary’s, 1997

    Google Scholar 

  15. Bennett C. Health care and risk in the new NHS: issues aroundcommissioning services. In: Coles E, Smith D, Tombs S, etal., editors. Risk management and society. Kluwer Academic Publishers. In press

  16. Forte P, Bowen T. HIV/AIDS care and treatment costs: forwardplanning. A report commissioned by The AIDS Awareness Trust. London: AIDS Awareness Trust, 1996

    Google Scholar 

  17. Department of Health. £23 Million boost for next year’sHIV/AIDS treatment budget [press release]. London: Departmentof Health, 1997 Oct 27

    Google Scholar 

  18. SAS/STAT User’s Guide. Version 6. 4th ed. Cary (NC): SASInstitute Inc, 1990

    Google Scholar 

  19. Centres for Disease Control. 1993 revised classification systemfor HIV infection and expanded surveillance case definitionfor AIDS among adolescents and adults. MMWR Morb Mortal Wkly Rep 1992; 41(RR-17): 1–19

    Google Scholar 

  20. Public Health Laboratory Service (PHLS) AIDS Centre. AIDS surveillance and HIV death clinical report form, London: PHLS Communicable Disease Surveillance Centre, 1993

    Google Scholar 

  21. Beck EJ. The National Prospective Monitoring System on theUse, Cost and Outcome of HIV Service Provision in English Hospitals: outcomes 1994-1996. An Extra-Ordinary NPMSSteering Group Meeting, Imperial College School of Medicineat St. Mary’s; 1997 Jan 30; London

    Google Scholar 

  22. Kinghorn G. The National Prospective Monitoring System onthe Use, Cost and Outcome of HIV Service Provision inEnglish Hospitals. NPMS Steering Group Meeting, ImperialCollege School of Medicine at St. Mary’s; 1997 Sep 22; London

    Google Scholar 

  23. National Health Service (NHS) Executive. Hospital and communityhealth services revenue (pay and prices) inflation index.Leeds: NHS Executive Finance and PerformanceDepartment A, 1997

    Google Scholar 

  24. Petrou S, Dooley M, Whitaker L, et al. Community services forpeople with HIV infection in London: a prospective study ofcost and utilization patterns. Health Trends 1995; 27: 62–8

    PubMed  CAS  Google Scholar 

  25. Beck EJ, Tolley K. Financing HIV services in England: estimatedimpact of the cost of anti-retroviral therapy. Int J STDAIDS 1998; 9: 512–7

    Article  CAS  Google Scholar 

  26. HIV and STD Division, Communicable Disease Surveillance Centre. AIDS/HIV quarterly surveillance tables: UK data tothe end December 1997. Colindale: Public Health Laboratory Service AIDS Centre, 1998

    Google Scholar 

  27. Beck EJ, Flori YA, Geoffard PY, et al. Uptake of combinationanti-retroviral therapy during 1996 and 1997: an Anglo-French comparison [abstract 42289]. 12th World AIDS Conference;1998 Jun 28-Jul 3: Geneva

    Google Scholar 

  28. Finkler SA. The distinction between cost and charges. Ann Intern Med 1982; 96: 102–9

    PubMed  CAS  Google Scholar 

  29. Beck EJ, Mandalia S Griffith R, et al. The Hospital and Community Services Study of Families with HIV Infection: initialanalyses of hospital service provision and costs forHIV-infected children St. Mary’s Hospital, 1986-1994. London: Department of Epidemiology and Public Health, ImperialCollege School of Medicine at St. Mary’s, 1997

    Google Scholar 

  30. Beck EJ, Kupek EJ, Petrou S, et al. Survival and the use andcosts of hospital services for London AIDS patients treatedwith AZT. Int J STD AIDS 1996; 7: 507–12

    Article  PubMed  CAS  Google Scholar 

  31. Hammer SM. Advances in antiretroviral therapy and viral loadmonitoring. AIDS 1996; 10 Suppl. 3: S1–11

    Google Scholar 

  32. Hammer SM, Katzenstein DA, Hughes MD, et al. A trial comparingnucleoside monotherapy with combination therapy inHIV infected adults with CD4 cell counts between 200 and500 per cubic millimeter. N Engl J Med 1996; 335: 1081–90

    Article  PubMed  CAS  Google Scholar 

  33. Saravolatz LD, Winslow Dl, Collins G, et al. Zidovudine aloneor in combination with didanosine or zalcitabine in HIV infectedpatients with the acquired immunodeficiency syndromeor fewer than 200 CD4 cells per cubic millimeter. NEngl J Med 1996; 335: 1099–106

    Article  CAS  Google Scholar 

  34. Delta Coordinating Committee. Delta: a randomised doubleblindcontrolled trial comparing combinations of zidovudineplus didanosine or zalcitabine with zidovudine alone in HIVinfectedindividuals. Lancet 1996; 348: 283–91

    Article  Google Scholar 

  35. Williams IG. Use of protease inhibitors. J HIV Comb Ther 1996;1: 4–7

    Google Scholar 

  36. Perelson AS, Essunger P, Cao Y-z, et al. Decay characteristicsof HIV-1 infected compartments during combination therapy.Nature 1997; 387: 188–91

    Article  PubMed  CAS  Google Scholar 

  37. Brown R, Simpson KN, Nabulsi A. Cost and consequences ofadding ritonavir to current antiretroviral therapy for advancedHIV patients in the United Kingdom and in the USA [abstractWeB 3126]. XI International Conference on AIDS; 1996 Jul7-12: Vancouver

    Google Scholar 

  38. Simpson K, Revicki D, Nabulsi A, et al. Adding ritonavir tocurrent antiretroviral therapy for advanced HIV patients in theUS: comparison of costs of care predicted by modelling andactual costs from trial setting [abstract ThB 4112]. XI International Conference on AIDS; 1996 Jul 7-12: Vancouver

    Google Scholar 

  39. Carpenter CC, Fischl MA, Hammer SM, et al. Antiretroviraltherapy for HIV infection in 1997. JAMA 1997; 277: 1962–9

    Article  PubMed  CAS  Google Scholar 

  40. Minimum standard of care (for adults with HIV). London: Treatment Action Taskforce, 1996

  41. Gazzard B, Moyle GJ, Weber J, et al. British HIV Association guidelines for antiretroviral treatment of HIV seropositive individuals.Lancet 1997; 349: 1086–92

    Article  Google Scholar 

  42. Gazzard B, Moyle GJ, British HIV Association GuidelinesWriting Committee. 1998 revision to the British HIV Associationguidelines for antiretroviral treatment of HIV seropositiveindividuals. Lancet 1998; 352: 314–6

    Article  PubMed  CAS  Google Scholar 

  43. Direction des Hospitaux, Mission SIDA. DMI2: an informationsystem built around the patient. Paris: INSERM-SC4,Ministere de la Sante et de l’action Humanitaire, 1993

    Google Scholar 

  44. Pozniak A. Surrogacy in HIV-1 clinical trials. Lancet 1998; 351:536–7

    Article  PubMed  CAS  Google Scholar 

  45. Lange JM. Current problems and the future of antiretroviraldrug trails. Science 1997; 276: 548–50

    Article  PubMed  CAS  Google Scholar 

  46. Beck EJ, Kupek EJ, Wadsworth J, et al. The use and cost ofhospital services by patients with different AIDS definingconditions treated at a national London AIDS referral centre.J Public Health Med 1996; 18: 457–64

    Article  PubMed  CAS  Google Scholar 

  47. Dijkgraaf MGW, Luijben AHP, Jager JC, et al. Inpatient carefor symptomatic HIV-infected persons: a longitudinal studyof hospitalizations, inpatient drug use and related costs. AIDS Care 1995; 7: 321–36

    Article  PubMed  CAS  Google Scholar 

  48. Postma MJ, Tolley K, Leidl RM, et al. Hospital care for personswith AIDS in the European Union: assessment of current andfuture impact controlled for severity-stages. Health Policy 1997; 41: 157–76

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Epidemiology and Public Health, NPMS Coordinating and Analytic Centre, Imperial College School of Medicine (St. Mary’s Campus), London, W2 1PG, England

    Eduard J. Beck, Amanda Power, Sundhiya Mandalia, Philippa Rutter & Junichi Izumi

  2. Department of Economics, Nottingham University, Nottingham, England

    Keith Tolley

  3. Personal Social Services Research Unit (PSSRU), University of Kent at Canterbury, Kent, England

    Jeni Beecham

  4. Health Economics Research Centre, Institute of Health Sciences, Oxford, England

    Alistair Gray

  5. Department of Genitourinary Medicine, St Thomas’ Hospital, London, England

    David Barlow

  6. Kobler Centre, Chelsea & Westminster Hospital, London, England

    Philippa Easterbrook

  7. Claude Nicol Centre, Royal County Sussex Hospital, Brighton, England

    Martin Fisher

  8. Department of Infectious Diseases, Birmingham Heartlands Hospital, Birmingham, England

    John Innes

  9. Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield, England

    George Kinghorn

  10. Monsall Department of Infectious Diseases, North Manchester General Hospital, Manchester, England

    Bibhat Mandel

  11. Academic Department of Genitourinary Medicine, King’s Hospital, London, England

    Anton Pozniak

  12. Department of Genitourinary Medicine, Royal Berkshire Hospital, Reading, England

    Allan Tang

  13. Department of Genitourinary Medicine, St Mary’s Hospital, London, England

    David Tomlinson

  14. Mortimer Market Centre, Middlesex Hospital, London, England

    Ian Williams

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  1. Eduard J. Beck
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  2. Keith Tolley
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  8. Alistair Gray
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  9. David Barlow
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  10. Philippa Easterbrook
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  11. Martin Fisher
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  12. John Innes
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  13. George Kinghorn
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  14. Bibhat Mandel
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  15. Anton Pozniak
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  16. Allan Tang
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  17. David Tomlinson
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  18. Ian Williams
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Correspondence to Eduard J. Beck.

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Beck, E.J., Tolley, K., Power, A. et al. The Use and Cost of HIV Service Provision in England in 1996. Pharmacoeconomics 14, 639–652 (1998). https://doi.org/10.2165/00019053-199814060-00005

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  • DOI: https://doi.org/10.2165/00019053-199814060-00005

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