THE IMPACT OF PROPHYLAXIS ON OUTCOME AND RESOURCE UTILIZATION IN PNEUMOCYSTIS-CARINII PNEUMONIA

Study objective: Pneumocystis carinii pneumonia (PCP) is a major late complication of HIV infection associated with morbidity and mortality. Because chemoprophylaxis is highly effective, cases of PCP can be vie wed as failures in the management of HIV disease. Methods: We reviewed demographic, clinical, and cost data for all cases of confirmed HIV-r elated PCP at The Johns Hopkins Hospital in 1991 to determine conseque nces of missed prophylaxis, We also analyzed hospital discharge data f or Maryland in 1991 to assess hospital charges, length of stay, and ou tcome for all patients with a principal diagnosis of HIV-related PCP. Results: Pneumocystis carinii pneumonia was diagnosed in 79 patients. Of the 79 patients, 61 (77%) did not receive prophylaxis, including 26 who were not previously known to have HIV infection, 17 who did not h ave prophylaxis prescribed, and 18 who had prophylaxis prescribed, but were not compliant with the regimen. Patients not taking prophylaxis accounted for all 12 deaths ascribed to PCP. This group also accounted for 85% of the hospital days, 100% of the ICU days, and 89% of the in patient charges. The total hospital charges were $849,540. Extrapolati on of these figures for the state of Maryland suggest that the failure to receive prophylaxis in 1991 resulted in 62 patient deaths and a co st of approximately $4.7 million. Conclusion: Patients who developed P CP despite prophylaxis had a better outcome and used fewer resources t han patients not receiving preventive therapy. This study emphasizes t he impact of PCP prophylaxis on the morbidity, mortality, and economic s of HIV health care.