Longitudinal patterns of medical service use and costs among people with AIDS

This study examines the effect of race, HIV transmission group, and decedent status on the use and cost of inpatient and outpatient care among people with AIDS.

Data come from 914 people with AIDS who were receiving services in nine cities across the United States in 1990-1991 and who indicated that a hospital clinic was their usual source of care. Review of hospital medical and billing records provided data on use and costs of medical services over an 18-month period. Vital status was determined from hospital records and death certificates.

Data from each respondent were aggregated into three-month intervals, beginning with the last quarter of data and working backward. Regression analyses using random-effect models and generalized estimating equations were conducted to assess temporal patterns of inpatient and outpatient use and costs.

Inpatient utilization and costs were higher for decedents than for nondecedents. However, differences between decedents and nondecedents varied as a function of race. Nonwhites had more inpatient use and higher costs than whites, but lower outpatient use, and these differences were greater among decedents. Inpatient nights and costs rose sharply in the six months prior to death. Outpatient use and costs did not display as strong a temporal trend.

Much of the cost of treating HIV infection is concentrated in the period immediately preceding death. The intensity of service use in the terminal period should be considered when developing estimates of annual costs of care and when designing programs to provide community-based treatment.