This study calculates the cost of medical care during the different stages of HIV infection, from the asymptomatic period to a confirmed AIDS diagnosis. Also, we have estimated the total cost of taking specimens and performing tests related to HIV infection, and the cost of information, research, etc. Medical costs were based on estimates of the average cost per day and the total number of days at the various stages of HIV infection. The cost estimates for testing include costs related to taking specimens, analysing samples, managing test results, etc. The cost outlook until 1990 is discussed using different assumptions concerning incidence, survival and the level of preventive efforts. The total estimated costs for medical care, HIV tests, information, etc. doubled between 1986 and 1987. During 1987, costs totaled 313 million Swedish kronor (SEK). The costs for specimens and tests totaled SEK 124 million, medical costs for HIV positives who had not developed AIDS totaled SEK 31 million, and medical costs for AIDS patients totaled SEK 26 million. The costs discussed in this study will probably increase by at least 50% by 1990.
Determining the direct cost of providing medical care to patients with HIV/AIDS is important for both short-term and long-term decision-making and for appropriate resource allocation. We aimed to categorize and measure the direct costs of medical care provided to the entire HIV-positive population receiving care in southern Alberta between 1995 and 2001.
We collected all patient-specific direct costs including the cost of pharmaceutical drugs (HIV and non-HIV drugs), outpatient care (including physician costs and laboratory testing), inpatient (in-hospital) care and home care (acute, long-term, palliative) from primary sources for all patients between April 1995 and April 2001. We determined cost per patient per month (PPPM) adjusted to 2001 Canadian dollars.
Since 1995, the direct cost of providing medical care to patients with HIV/AIDS has increased primarily as a result of increased antiretroviral drug costs both in absolute and in PPPM terms. Mean PPPM expenditures increased from 655 Canadian dollars in 1995/96, that is, before the use of highly active antiretroviral therapy (HAART), to 1036 Canadian dollars in 1997/98 when HAART was widely used. During the following 3 years, mean overall PPPM costs remained stable. Antiretroviral drugs accounted for 30% (198 Canadian dollars PPPM) of the total cost in 1995/96 increasing to 69% (775 Canadian dollars PPPM) in 2000/01. Inpatient, outpatient and home care costs decreased in both percentage and cost PPPM between 1995/96 and 2000/01 from 26% to 10%, 27% to 14% and 8% to 3% respectively.
The cost of providing medical care to HIV-positive patients continues to increase, although the burden of costs is distributed differently from before the introduction of HAART, with the costs of drug therapy offsetting the costs of inpatient care and home care. Careful consideration of all aspects of direct costing data is needed when any health economic policy issues are examined.
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To assess the economic impact of HIV (human immunodeficiency virus) antibody screening among potential immigrants on Canada's health care system we estimated the costs and benefits of such screening among the 160 135 immigrants who entered Canada in 1988 using the in-hospital costs of treating AIDS (acquired immune deficiency syndrome) over the 10 years after immigration. This economic model was based on current international HIV seroprevalence data, Canadian immigration statistics and estimates of disease progression. Between 343 and 862 of the immigrants were estimated to have been HIV seropositive; with the use of the enzyme-linked immunosorbent assay and the Western blot technique 310 to 780 of them would have been correctly identified as being seropositive, and 33 to 82 would have been incorrectly classified as being seronegative. Another 16 would have been falsely classified as being seropositive. There would have been 151 to 379 cases of AIDS from 1988 to 1998 among the immigrants identified as being HIV-positive. The estimated total cost of screening would have been $3.3 to $3.4 million. The in-hospital costs of treating HIV-infected immigrants in whom AIDS developed between 1989 and 1998 would have been $5.0 to $17.1 million. Accordingly, screening would have saved $1.7 to $13.7 million over the 10 years after immigration. However, we do not advocate screening on the basis of economic analysis alone and acknowledge that any policy regarding such screening must also incorporate social, legal and ethical considerations.
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