PEDIATRIC HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION - RECENT-EVIDENCE ONTHE UTILIZATION AND COSTS OF HEALTH-SERVICES

Objective: To measure the utilization and costs of pediatric human imm unodeficiency virus (HIV)-related health care services. Design: Cohort survey. Setting: Eight outpatient departments serving large numbers o f HIV-infected children in five standard metropolitan areas with high prevalence of HIV-infected children. Patients: One hundred forty-one H IV-seropositive children older than 15 months of age or children whose clinical conditions meet the definition of acquired immune-deficiency syndrome (AIDS) at any age who visited the selected providers during the second quarter of 1991. Interventions: None. Main Outcome Measures : Quarterly interview survey (via adult proxies) of health care servic es utilization during each preceding 3-month period, repeated six time s between March 1991 and August 1992. Charge data were abstracted from inpatient, outpatient, home health care, and pharmacy bills. Results: Children with AIDS averaged 1.4 hospitalizations, 16 inpatient days, two emergency department visits, 18 ambulatory care visits, 15 profess ional home health care visits, and one dental visit per year, generati ng an estimated $37 928 in annual charges. The HIV-infected children u sed fewer services, with annual charges of $9382. Conclusions: We foun d lower utilization than reported in prior research on pediatric HIV a nd similar unit costs after inflation adjustment. Increasing experienc e in clinical management and expanded ambulatory care may have contrib uted to reductions in inpatient services utilization and total costs s ince the mid-1980s.