Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
The care of HIV-infected adults in the United States. HIV Cost and Services Utilization Study Consortium [see comments]
N Engl J Med. 1998 Dec 24;339(26):1897-904. Unique Identifier : AIDSLINE MED/99067155 Bozzette SA; Berry SH; Duan N; Frankel MR; Leibowitz AA; Lefkowitz D; Emmons CA; Senterfitt JW; Berk ML; Morton SC; Shapiro MF; RAND Health, Santa Monica, CA, USA.
Abstract:
BACKGROUND AND METHODS: In order to elucidate the medical care of patients with human immunodeficiency virus (HIV) infection in the United States, we randomly sampled HIV-infected adults receiving medical care in the contiguous United States at a facility other than military, prison, or emergency department facility during the first two months of 1996. We interviewed 76 percent of 4042 patients selected from among the patients receiving care from 145 providers in 28 metropolitan areas and 51 providers in 25 rural areas. RESULTS: During the first two months of 1996, an estimated 231,400 HIV-infected adults (95 percent confidence interval, 162,800 to 300,000) received care. Fifty-nine percent had the acquired immunodeficiency syndrome according to the case definition of the Centers for Disease Control and Prevention, and 91 percent had CD4+ cell counts of less than 500 per cubic millimeter. Eleven percent were 50 years of age or older, 23 percent were women, 33 percent were black, and 49 percent were men who had had sex with men. Forty-six percent had incomes of less than $10,000 per year, 68 percent had public health insurance or no insurance, and 30 percent received care at teaching institutions. The estimated annual direct expenditures for the care of the patients seen during the first two months of 1996 were $5.1 billion; the expenditures for the estimated 335,000 HIV-infected adults seen at least as often as every six months were $6.7 billion, which is about $20,000 per patient per year. CONCLUSIONS: In this national survey we found that most HIV-infected adults who were receiving medical care had advanced disease. The patient population was disproportionately male, black, and poor. Many Americans with diagnosed or undiagnosed HIV infection are not receiving medical care at least as often as every six months. The total cost of medical care for HIV-infected Americans accounts for less than 1 percent of all direct personal health expenditures in the United States.
Keywords: JOURNAL ARTICLE Acquired Immunodeficiency Syndrome/THERAPY Adult Cohort Studies Delivery of Health Care/ECONOMICS/*STATISTICS & NUMER DATA/ UTILIZATION Female Health Expenditures/*STATISTICS & NUMER DATA Health Resources/ECONOMICS/STATISTICS & NUMER DATA/UTILIZATION Human HIV Infections/ECONOMICS/ETHNOLOGY/EPIDEMIOLOGY/*THERAPY Male Middle Age Sampling Studies Socioeconomic Factors Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S. United States/EPIDEMIOLOGY Comment in: N Engl J Med 1998 Dec 24;339(26):1926-8
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Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
