How good are US studies of HIV costs of care?

BACKGROUND. Valid, timely estimates of the costs of HIV care are needed by health planners and policy makers. OBJECTIVE. To perform a methodologic critique of published estimates of res ource utilization and costs of HIV care. DATA SOURCES. MEDLINE database for 1990-1998. DATA SELECTION. Included articles focused on adults with a spectrum of HIV disease in which the authors developed their own resource use and cost data . Thirty one articles met these criteria. DATA EXTRACTION. Studies were compared based on: (1) utilization and cost e stimates, in 1995 dollars; (2) study period; (3) research design; (4) sampl ing frame; (5) sample size and patient characteristics; (6) data sources an d scope of services; and (7) methods used in the analysis. DATA SYNTHESIS. The most recent estimates pertain to the first half of 1995 , before the use of protease inhibitor therapy. We found wide variations in the estimates and identified three major sources for this: (1) patient sam ples that were restricted to subgroups of the national HIV-infected populat ion; (2) utilization data that were limited in scope leg, inpatient (are on ly); and (3) invalid methods for estimating annual or lifetime costs, parti cularly in dealing with decedents. CONCLUSIONS. TO accurately estimate resource use and costs for HIV care nat ionwide, a nationally representative probability sample of HIV-infected pat ients is required. Even in research that is not intended to provide nationa l estimates, the scope of utilization data should be broadened and greater attention to methodologic issues in the analysis of annual and lifetime cos ts is needed.