Michael Carter, Thursday, June 21, 2007
Hospital admission involving HIV-positive individuals fell by almost 40% between 2000 and 2004, a US study, published in the June 1st edition of the Journal of Acquired Immune Deficiency Syndromes reports. The study, which looked at hospitalisations in six US states, also found that the average age of patients with HIV being admitted to hospital increased. The author of the study suggests that this is due to the general ageing of the HIV-positive population thanks to the success of antiretroviral therapy. However, such ageing is having an important impact on the type of illnesses HIV-positive patients develop, and the author notes that it is increasingly probable that people with HIV “are likely to be treated for conditions that affect the general population of hospital patients, such as gastrointestinal disorders, cardiovascular problems, and cancer.”
The US federal government spends in excess of US$12 billion per year on HIV care. The proportion of expenditure per-patient devoted to paying for hospital care has fallen significantly since the introduction of potent antiretroviral therapy. Indeed, in the early years of the HIV epidemic nearly all the money spent on patient care was devoted to paying for in-patient treatment, but by 1998, only two years into the era of effective anti-HIV therapy, this had fallen to 38%.
Dr FJ Hellinger, a healthcare researcher, wished to see if there had been any changes in the pattern of hospital care required by people with HIV between 2000 and 2004. Information was gathered from six US states (California, Florida, New Jersey, New York, South Carolina and Washington State, selected to have a broad geographical spread and to include high- and low-prevalence states). Dr Hellinger compared the number of total admissions in 2000 and 2004, the health of patients at the time of their hospitalisation, and age, gender, and ethnicity.
In 2000 there were 91,343 admissions to hospital involving HIV-positive patients. This fell to 72,829 admissions in 2004. Overall this was a 20% reduction in admissions. However, during this period there was also a 28% increase in the total number of people living with HIV. Taking into account this increase in HIV prevalence, Dr Hellinger calculated that hospital admissions actually fell by 39% in the four-year period. This meant that there was a 44% reduction in the average monthly cost to provide hospital care to HIV-positive patients.
A general ageing in HIV-positive patients requiring admission to hospital was also observed. In 2000, individuals requiring in-patient care had an average age of 41 years, but by 2004 this had increased to 44 years. Patients admitted to hospital in 2004 were in poorer health than those hospitalised in 2000 – the average number of diagnoses per patient in 2000 was six, but this had increased to seven by 2004. Dr Hellinger also noted that there was a very slight increase in the average duration of each admission to hospital from 8.3 days in 2000 to 8.4 days four years later.
There were no significant shifts in the gender or ethnicity of patients requiring in-patient care. In both 2000 and 2004, 34% of those hospitalised were women and 51% were black.
Dr Hellinger concludes that the information provided by his study is a “prerequisite for physicians and planners to ensure that persons living with HIV receive the appropriate mix of health care services.”