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Pediatric human immunodeficiency virus infection. Recent evidence on the utilization and costs of health services
D C Hsia1, J A Fleishman, J A East
1Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, Rockville, MD, USA.
Insights
Pediatric human immunodeficiency virus (HIV) care costs are lower than previously reported, with children with acquired immunodeficiency syndrome (AIDS) incurring higher annual charges than HIV-infected children. Advances in clinical management and ambulatory care likely reduced inpatient utilization and overall expenses.
Area of Science:
- Pediatric Health Services Research
- Infectious Disease Epidemiology
- Health Economics
Background:
- Pediatric human immunodeficiency virus (HIV) care has evolved significantly, necessitating updated assessments of healthcare utilization and associated costs.
- Previous studies may not reflect current trends in management and treatment for pediatric HIV and acquired immunodeficiency syndrome (AIDS).
Purpose of the Study:
- To quantify the healthcare services utilization and associated costs for pediatric patients with HIV and AIDS.
- To establish a benchmark for current pediatric HIV/AIDS healthcare expenditures.
Main Methods:
- A cohort survey design was employed, involving quarterly interviews with adult proxies for 141 HIV-seropositive children and children meeting AIDS criteria.
- Data collection spanned from March 1991 to August 1992 across eight outpatient departments in high-prevalence metropolitan areas.
- Healthcare utilization and charges were meticulously recorded for inpatient, outpatient, home health, and pharmacy services.
Main Results:
- Children with AIDS incurred significantly higher annual healthcare charges ($37,928) compared to HIV-infected children ($9,382).
- Annual service utilization for children with AIDS included an average of 1.4 hospitalizations and 18 ambulatory care visits.
- HIV-infected children demonstrated lower service utilization across all categories.
Conclusions:
- Current healthcare utilization for pediatric HIV/AIDS is lower than previously documented, with adjusted unit costs remaining stable.
- Improvements in clinical management and expanded ambulatory care access appear to have reduced inpatient service utilization and overall costs since the mid-1980s.
- These findings underscore the impact of evolving medical practices on healthcare resource allocation in pediatric HIV/AIDS management.
Objective:
To measure the utilization and costs of pediatric human immunodeficiency virus (HIV)-related health care services.
Design:
Cohort survey.
Setting:
Eight outpatient departments serving large numbers of HIV-infected children in five standard metropolitan areas with high prevalence of HIV-infected children.
Patients:
One hundred forty-one HIV-seropositive children older than 15 months of age or children whose clinical conditions meet the definition of acquired immunodeficiency syndrome (AIDS) at any age who visited the selected providers during the second quarter of 1991.
Interventions:
None.
Main Outcome Measures:
Quarterly interview survey (via adult proxies) of health care services utilization during each preceding 3-month period, repeated six times between March 1991 and August 1992. Charge data were abstracted from inpatient, outpatient, home health care, and pharmacy bills.
Results:
Children with AIDS averaged 1.4 hospitalizations, 16 inpatient days, two emergency department visits, 18 ambulatory care visits, 15 professional home health care visits, and one dental visit per year, generating an estimated $37,928 in annual charges. The HIV-infected children used fewer services, with annual charges of $9382.
Conclusions:
We found lower utilization than reported in prior research on pediatric HIV and similar unit costs after inflation adjustment. Increasing experience in clinical management and expanded ambulatory care may have contributed to reductions in inpatient services utilization and total costs since the mid-1980s.
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