LONGITUDINAL PATTERNS OF MEDICAL-SERVICE USE AND COSTS AMONG PEOPLE WITH AIDS

Objective. This study examines the effects of race, HIV transmission g roup, and decedent status on the use and cost of inpatient and outpati ent care among people with AIDS. Data Sources. Data come from 914 peop le with AIDS who were receiving services in nine cities across the Uni ted States in 1990-1991 and who indicated that a hospital clinic was t heir usual source of care. Review of hospital medical and billing reco rds provided data on use and costs of medical services over an 18-mont h period. Vital status was determined from hospital records and death certificates. Study Design. Data from each respondent were aggregated into three-month intervals, beginning with the last quarter of data an d working backward. Regression analyses using random-effect models and generalized estimating equations were conducted to assess temporal pa tterns of inpatient and outpatient use and costs. Principal Findings. Inpatient utilization and costs were higher for decedents than for non decedents. However, differences between decedents and nondecedents var ied as a function of race. Nonwhites had more inpatient use and higher costs than whites, but lower outpatient use, and these differences we re greater among decedents. Inpatient nights and costs rose sharply in the six months prior to death. Outpatient use and costs did not displ ay as strong a temporal trend. Conclusions. Much of the cost of treati ng HIV infection is concentrated in the period immediately preceding d eath. The intensity of service use in the terminal period should be co nsidered when developing estimates of annual costs of care and when de signing programs to provide community-based treatment.