Ej. Beck et al., THE USE AND COST OF HOSPITAL SERVICES BY LONDON AIDS PATIENTS WITH DIFFERENT AIDS-DEFINING CONDITIONS, Journal of public health medicine, 18(4), 1996, pp. 457-464
Background Contracting for HIV service provision is now an established
part of the National Health Service commissioning process. AIDS is a
heterogeneous condition, comprising Various opportunistic illnesses wh
ich require different services and which have different resource impli
cations. This study describes the use of hospital services and associa
ted costs for the management of different AIDS defining conditions. Me
thod A retrospective case-notes analysis was performed, of 335 AIDS pa
tients treated at St Mary's Hospital, London, between 1 January 1983 e
nd 30 September 1989, as well as a costing exercise of 37 clinical dep
artments to calculate HIV-related costs. Results Mean age at time of A
IDS diagnosis for these predominantly homosexual men was 38 years. Use
of services varied. as did associated costs - from pound 8163 per pat
ient-year for patients with Constitutional Disease to pound 42124 for
those with Cytomegalovirus Disease. Most diagnostic categories showed
a shift over the study period from an in-patient- to an out-patient-ba
sed service. Patients diagnosed after 1987 had overall lower costs per
patient-year compared with those diagnosed before 1987; whereas out-p
atient costs for most groups had increased, in-patient expenditure dec
reased. For most categories, in-patient care costs and out-patient dru
gs prescribed provided the greatest proportion of total costs. Average
costs per in-patient day ranged from pound 334 to pound 433, and aver
age costs per out-patient visit ranged from pound 99 to pound 411 for
different AIDS defining conditions. Conclusions Different opportunisti
c illnesses of symptomatic HIV disease have different treatment and re
source implications. Casemix will need to be taken into consideration
when contracting for HIV services, including extra-contractual referra
ls.