caa a22 4500 397577397 CHVBK 20180308164859.0 cr unu---uuuuu 161202e199612 xx s 000 0 eng 10.1093/oxfordjournals.pubmed.a024545 doi (NATIONALLICENCE)oxford-10.1093/oxfordjournals.pubmed.a024545 The use and cost of hospital services by London AIDS patients with different AIDS defining conditions [Elektronische Daten] [Eduard J. Beck, Emil J. Kupek, Jane Wadsworth, David L. Miller, Anthony J. Pinching, John R. W. Harris] Background Contracting for HIV service provision is now an established part of the National Health Service commissioning process. AIDS is a heterogeneous condition, comprising various opportunistic illnesses which require different services and which have different resource implications. This study describes the use of hospital services and associated costs for the management of different AIDS defining conditions. Method A retrospective case-notes analysis was performed, of 335 AIDS patients treated at St Mary's Hospital, London, between 1 January 1983 and 30 September 1989, as well as a costing exercise of 37 clinical departments to calculate HIV-related costs. Results Mean age at time of AIDS diagnosis for these predominantly homosexual men was 38 years. Use of services varied, as did associated costs - from £8163 per patient-year for patients with Constitutional Disease to £42124 for those with Cytomegalovirus Disease. Most diagnostic categories showed a shift over the study period from an in-patient- to an out-patient-based service.Patients diagnosed after 1987 had overall lower costs perpatient-year compared with those diagnosed before 1987; whereas out-patient costs for most groups had increased, in-patient expenditure decreased. For most categories, in-patient care costs and out-patient drugs prescribed provided the greatest proportion of total costs. Average costs per in-patient day ranged from £334 to £433, and average costs per out-patient visit ranged from £99 to £411 for different AIDS defining conditions. Conclusions Different opportunistic illnesses of symptomatic HIV disease have different treatment and resource implications. Casemix will need to be taken into consideration when contracting for HIV services, including extra-contractual referrals. © Oxford University Press Articles nationallicence AIDS nationallicence casemix nationallicence service provision nationallicence costs nationallicence Beck Eduard J. Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, Norfolk Place, London W2 1PG aut Kupek Emil J. Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, Norfolk Place, London W2 1PG aut Wadsworth Jane Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, Norfolk Place, London W2 1PG aut Miller David L. Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, Norfolk Place, London W2 1PG aut Pinching Anthony J. Department of Immunology, Medical College of St Bartholomew's Hospital London aut Harris John R. W. Department of Immunology, Medical College of St Bartholomew's Hospital London aut Journal of Public Health Oxford University Press 18/4(1996-12), 457-464 1741-3842 18:4<457 1996 18 pubmed https://doi.org/10.1093/oxfordjournals.pubmed.a024545 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/oxfordjournals.pubmed.a024545 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Beck Eduard J. Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, Norfolk Place, London W2 1PG aut NATIONALLICENCE 700 1- Kupek Emil J. Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, Norfolk Place, London W2 1PG aut NATIONALLICENCE 700 1- Wadsworth Jane Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, Norfolk Place, London W2 1PG aut NATIONALLICENCE 700 1- Miller David L. Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, Norfolk Place, London W2 1PG aut NATIONALLICENCE 700 1- Pinching Anthony J. Department of Immunology, Medical College of St Bartholomew's Hospital London aut NATIONALLICENCE 700 1- Harris John R. W. Department of Immunology, Medical College of St Bartholomew's Hospital London aut NATIONALLICENCE 773 0- Journal of Public Health Oxford University Press 18/4(1996-12), 457-464 1741-3842 18:4<457 1996 18 pubmed Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford