农村地区艾滋病抗病毒治疗的直接成本分析

Direct Cost Analysis of Therapy on HIV-1 Infection in Rural Area of China

目的:估算我国综合性艾滋病研究项目(China integrated program for research on AIDS,China,CIPRA)临床治疗的直接成本,为在我国农村地区推行艾滋病(HIV/AIDS)高效抗逆转录病毒治疗(Highly Active Anti-retroviral therapy,HAART)提供卫生经济学方面的参考依据。方法:收集治疗的成本资料,根据当地的医疗服务价格水平,估算包括抗病毒药品费用、随访检查费用及不良事件(adverse event,AE)处理费用的直接成本。结果:治疗1年期间,100例患者因不良事件平均每人住院为3.5天,每人门诊治疗为3.6次,平均每日住院费用和每次门诊费用分别为186.8元和43.0元。每人治疗总费用为26521.3元,其中抗病毒药品费用占67.0%,有效性监测费用占26.4%,安全性监测费用占3.5%,不良事件处理费用占3.0%,处理不良事件的费用约占当地农民人年均收入的30.0%。结论:按本方案在中国中西部农村地区以县级医疗机构为基点开展HAART治疗,每人每年的直接成本约为26500.0元,安全性监测费用占总费用比例较小,是为保证HAART治疗安全必须优先投入的部分。不良事件处理费用成为当地HIV/AIDS患者的重要经济负担,需要相应的补偿机制予以分担。

Objectives To estimate the direct cost of therapy aeeording to HIV/AIDS China CIPRA P4 regimens, and to supply referential data on health economy in planning the national HAART in rural areas. Method The treatment cost data, including laboratory test, prescription and hospitalization was calculated to estimate the direct costs of HAART according to the local practice priee, including antiretroviral drug, laboratory test and AE treatment. Results During one year treatment period, 100 subjects had 3.5 mean inpatient days and 3.6 mean outpatient visits. The average inpatient cost was 186.8 Yuan per day and the average outpatient cost was 43.0 Yuan per visit. According the protocol, the direct cost is 26 521.3 Yuan per patient year, with 67.0% fur antiretruviral drugs, 26.4% for efficacy monitoring, 3.5% for safety monitoring and 3.0% fur AE treatment. Cost for AE treatment is about 30.0% of each farmer＇s net income per year. Conclusion If HAART is performed on district hospital in rural areas of center-west provinces, the direct cost will be about 26 500 per person-year, safety lab monitoring cost accounts a small pereentage of the total cost and is essential to insure the safety of therapy. Cost of treating AE will be a great eeonomic tmrden tbr HIV patients, subsidiary programs must be developed to share the patients＇ burden.