Document 0638
 DOCN  M9480638
 TI    Changing presentation and survival, service utilization and costs for
       AIDS patients: insights from a London referral centre.
 DT    9410
 AU    Beck EJ; Whitaker L; Kennelly J; McKevitt C; Wadsworth J; Miller DL;
       Easmon C; Pinching AJ; Harris JR; Academic Department of Public Health,
       St Mary's Hospital and; Medical School, London, UK.
 SO    AIDS. 1994 Mar;8(3):379-84. Unique Identifier : AIDSLINE MED/94304560
 AB    OBJECTIVE: To describe the use of services and associated costs for
       HIV-infected patients by stage of infection in the context of changing
       patterns of presentation and survival. METHODS: A retrospective analysis
       of inpatient and outpatient case-notes of 335 AIDS patients and a survey
       of HIV-related care provided by 37 departments at St Mary's Hospital,
       London. Survival from time of diagnosis of AIDS, time from diagnosis of
       HIV infection to AIDS, and use and costs of services per patient-year
       were outcome measures. RESULTS: During the study period 1 January 1982
       to 30 September 1989, 152 AIDS patients were diagnosed before 1987
       (group 1) and 183 since 1987 (group 2), most of whom were homosexual
       men. The median interval of first HIV-related visit to diagnosis of AIDS
       increased from 0 (group 1) to 264 days (group 2; P < 0.0001). Median
       survival from AIDS diagnosis increased from 14.6 (group 1) to 21.0
       months (group 2; P < 0.02). Group 2 patients used fewer inpatient
       services than group 1 patients irrespective of disease stage.
       Symptomatic patients in group 2 used more outpatient services than group
       1 patients. Total HIV-related expenditure was lower for patients without
       AIDS in group 2 than in group 1, while expenditure for AIDS patients
       remained similar. CONCLUSION: Earlier patient presentation, a shift from
       inpatient- to outpatient-based clinical care and increased survival from
       time of AIDS diagnosis has occurred. Increased drug expenditure was
       offset by reduced inpatient expenditure. Total expenditure per
       patient-year was stable; increased survival and introduction of new
       drugs will increase future lifetime use of resources.
 DE    Acquired Immunodeficiency Syndrome/*ECONOMICS/*MORTALITY/THERAPY  Adult
       Ambulatory Care/ECONOMICS/TRENDS/UTILIZATION  Female  Hospital
       Costs/*TRENDS  Hospitalization/ECONOMICS/STATISTICS & NUMER DATA/TRENDS
       Hospitals, Urban/ECONOMICS/TRENDS/*UTILIZATION  Human
       London/EPIDEMIOLOGY  Male  Referral and Consultation  Retrospective
       Studies  Support, Non-U.S. Gov't  Survival Analysis  JOURNAL ARTICLE

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