Reduction in hospitalization costs, morbidity, disability, and mortality in patients with AIDS treated with protease inhibitors

Background The objective of this study was to analyze hospitalization costs , morbidity, disability, and mortality in patients with acquired immunodefi ciency syndrome (AIDS) treated with protease inhibitors (PI), Methods. This is a self-controlled, ambispective study of a total of 581 pa tients with human immunodeficiency virus (HIV)/AIDS seen at the Hospital de Infectologia, Centro Medico La Raza, IMSS, in Mexico City during 1997. A t otal of 210 (36.14%) patients initiated protease inhibitor (PI) treatment a t the onset of the study. Thirty-eight patients satisfied the inclusion cri teria for this study and were analyzed retrospectively during the year prio r to PI treatment, and then prospectively throughout the year on PI treatme nt. As concerns main outcome measures, financial costs, number of hospitali zations, number of infections, and productivity and laboratory parameters ( CD4+ counts and viral load) were analyzed during the year prior to PI treat ment and then prospectively during the year on PI prescription. Our hypothe sis was that the hospital costs, morbidity, disability, and mortality of pa tients with AIDS decreased while on PI treatment. Results. During the year prior to PI prescription, the 38 patients enrolled in the study were admitted on a total of 59 occasions (1.55 hospitalizatio ns/patient), whereas during the year on PI therapy, all 38 patients had onl y seven admissions (0.18 hospitalizations/patient). Hospitalization costs d ecreased 35% when annual PI costs for the 38 patients studied were taken in to account. The number of microorganisms detected during hospitalization de creased from 24 prior to PI to five on PI. The number of disability days in volved in patients on PI decreased significantly (p <0.0002). None of the 3 8 patients studied died during the year of follow-up under PI treatment. Mo rtality decreased significantly, from 116/481 (23.2%) in 1996, to 77/581 (1 3.2%) in 1997, to 40/740 (6.4%) in 1998. There were no deaths among the 38 patients studied during the 1-year follow-up period; when the observation p eriod was extended 1 additional year, only one patient died (2.63%). Only s ix (3.48%) of the 172 PI-treated patients with AIDS not included in the stu dy died during the same period. CD4+ cell counts increased from 190.56 +/- 169.5 cells/mm(3) to 235.00 +/- 112.65 cells/mm(3) (p <0.05) after 12 month s of PI treatment. Viral loads decreased from 5 logs to 2.4 logs at 12 mont hs of PI treatment (p <0.001). Conclusions. Introduction of PI to antiretroviral treatment in patients wit h AIDS was associated with a lower rate of hospital admissions, lower costs , and a lesser number of infections/year, disabilities, and mortalities. In crease of CD4+ cell counts and decrease in viral loads in the 38 patients w ere associated with decreased morbility and mortality. (C) 2001 IMSS. Publi shed by Elsevier Science Inc.