CHANGING PRESENTATION AND SURVIVAL, SERVICE UTILIZATION AND COSTS FORAIDS PATIENTS - INSIGHTS FROM A LONDON REFERRAL CENTER

Objective: To describe the use of services and associated costs for HI V-infected patients by stage of infection in the context of changing p atterns of presentation and survival. Methods: A retrospective analysi s of inpatient and outpatient case-notes of 335 AIDS patients and a su rvey of HIV-related care provided by 37 departments at St Mary's Hospi tal, London. Survival from time of diagnosis of AIDS, time from diagno sis of HIV infection to AIDS, and use and costs of services per patien t-year were outcome measures. Results: During the study period 1 Janua ry 1982 to 30 September 1989, 152 AIDS patients were diagnosed before 1987 (group 1) and 183 since 1987 (group 2), most of whom were homosex ual men. The median interval of first HIV-related visit to diagnosis o f AIDS increased from 0 (group 1) to 264 days (group 2; P < 0.0001). M edian 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 s ervices than group 1 patients irrespective of disease stage. Symptomat ic patients in group 2 used more outpatient services than group 1 pati ents. Total HIV-related expenditure was lower for patients without AID S in group 2 than in group 1, while expenditure for AIDS patients rema ined similar. Conclusion: Earlier patient presentation, a shift from i npatient- to outpatient-based clinical care and increased survival fro m 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 wil l increase future lifetime use of resources.