The Direct Medical Costs Analysis Of National Free Antiretroviral Treatment For HIV/AIDS Patients

Objective: To analyse the structure, distribution and influencing factors of the direct medical costs on antiretroviral treatment for HIV/AIDS patients; to provide reference for nation or local goverments to make relative compensation policies and relief programs on antiretroviral treatment of AIDS and treatment of adverse reactions as well as opportunistic infections.Materials and Methods: The reviewing medical record method was adopted to collect the basic and direct medical costs information of HIV/AIDS patients who accepted nationl free antiretroviral treatment in three designated hospitals in charge of the work of HIV/AIDS treatment in Dehong, Yunnan province. 176 HIV/AIDS patients' medical records were collected. According to the different treatment aims, we divided the direct medical costs into four parts, the costs of antiretroviral drug, the costs of conventional inspection, the costs of adverse reactions treatment and the costs of opportunistic infections treatment. Data input was accomplish though establishing EPIDATA 3.1 software and EXCEL Database. The structure, distribution and influencing factors of direct medical costs was analysed by such kind of statistical methods as chi-square test, rank-sum test and non-conditional logistic regression model.Results: (1) Among the 164 patients treated for more than one year, the mean direct medical costs of antiretroviral treatment was 18562 yuan per person for the first year, which included 16204 yuan for antiretroviral drugs, 505 yuan for conventional inspection (excluding CD4 cell count testing), 1012 yuan for adverse reaction treatment, 841 yuan for opportunistic infections treatment, accounting for 87.84%, 2.75%, 5.14% and 4.26% of the direct medical costs respectively. (2) across CD4 cell count strata for the first year, Expenditure for antiretroviral drugs and conventional inspection were relatively constant at 16000-17000 yuan and 500 yuan per person respectively. Expenditure of adverse reaction and opportunistic infections for patients with CD4 cell counts<100 cells/mm~3 were 3.13 and 9.24 times greater than expenditure for patients with CD4 cells count≥200 cells/mm~3 . (3) Among the 29 patients with a treatment duration more than two years, the mean direct medical costs of antiretroviral treatment was 18409 yuan per person for the second year, including 17850 yuan for antiretroviral drugs(AZT+3TC+NVP), 160 yuan for conventional inspection (excluding CD4 cell count testing), 24 yuan for adverse reaction treatment, 374 yuan for opportunistic infections treatment, which accounted for 96.97%t, 0.87%, 0.13%t and 2.03% of direct medical costs respectively. (4) Treatment program, hospitalization, CD4 cell count strata were the influencing factors of the direct medical costs (5) Common adverse reactions were liver toxicity , skin rashes, gastrointestinal symptoms, anemia, systemic symptoms, neurological symptoms and other discomfort; the diseases incidence were 50.57%, 30.11%, 15.34%, 9.1%, 6.25%, 1.7% and 4.55% and the average treatment expenditures were 1,637 yuan, 1,070 yuan and 1,341 yuan, 217 yuan, 701 yuan, 7,517 yuan and 376 yuan. per person for first yeat respectively .(6)Common opportunistic infections were respiratory infections, PCP, diarrhea, fungal infections, herpes virus infections, tuberculosis (TB), cytomegalovirus infection (CMV) and other infectious diseases, the diseases incidence were 35.8%, 11.36%, 10.8%, 7.39%, 4.55%, 3.98%, 1.14%, 6.82%, the average expenditures were 1,091 yuan, 17 yuan, 765 yuan, 2,134 yuan and 1,688 yuan, 3,190 yuan ,10,107 yuan and 4,459 yuan per personfor first year respectively.Conclusions: The mean direct medical costs of anti-retroviral treatment for HIV/AIDS patients was about 20000 yuan for first year, the anti -retroviral drug costs accounted for the major proportion.The costs of conventional inspection, adverse reactions treatment, opportunistic infections treatment for the second year were significantly lower than that of the first year, there was no difference of anti-retroviral drug costs between the two years. The lower of CD4 baseline at the initial treatment, the higher of the corresponding direct medical costs, was primarily because of increased expenditures for the treantment of adverse reactions and opportunistic infections. Hospitalization, CD4 cell counts<200cells/mm~3, and the treatment programs AZT+3TC+NVP or D4T+3TC+EFV would increase the direct medical costs. The diseases incidence and treatment costs of adverse reactions and opportunistic infections were higher at the initial stage of anti-retroviral treatment.