Skip to main content
Log in

Use and Cost of Hospital and Community Service Provision for Children with HIV Infection at an English HIV Referral Centre

  • Original Research Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Objective: To describe the use of hospital and community services for children infected with HIV and estimate the cost per patient-year by stage ofHIV infection during the era of antiretroviral monotherapy.

Design: Data on the use of hospital services were collected from case notes; the use of statutory and nonstatutory community services was recorded through diaries and interviews. Total cost estimates were calculated from unit costs from relevant hospital departments and community organisations.

Setting: Children managed at St. Mary’s Hospital (London, England) between 1 January 1986 and 31 December 1994, some of whom used statutory and nonstatutory community services in South East England between 1 November 1994 and 31 May 1996.

Patients and participants: 118 children with positive HIV antibody status.

Main outcome measures and results: Mean inpatient days, outpatient visits, tests and procedures performed, drugs prescribed, community services used, associated unit costs and average cost estimates per patient-year by stage of HIV infection (1995/1996 values), and lifetime costs.

Service provision during the study period was predominantly hospital-based. The use of services increased for different stages of HIV infection and increased with increasing severity of HIV infection. A shift from an inpatient-based to an outpatient-based service was seen between the periods 1986 to 1991 and 1992 to 1994. As symptoms evolved, children used more hospital inpatient services, with an accompanying shift in the use of community services from general services, such as schooling, to increased use of nurses, social care and home help. The estimated total cost of hospital and community carewas £18 600 per symptomatic non-AIDS patient per year and £46 600 per AIDS patient per year. Similar estimates for children with indeterminate HIV infection and asymptomatic infection amounted to £8300 and £4800 per patient-year, respectively. Nondiscounted lifetime costs for hospital care amounted to £152 400 (£44 300 to £266 800) compared with discounted lifetime costs of £122 700 (£42 000 to £182 200); nondiscounted lifetime costs for community care amounted to £24 300 (£7900 to £41600) compared with discounted lifetime costs of £21 000 (£6800 to £32 000).

Conclusions: The continued emphasis on the use of hospital services may be due to the small number of children infected with HIV, most of whom lived in the London metropolitan area where specialist carewas concentrated in a few centres. Ashift from an inpatient- to an outpatient-based service was observed over time; the advent of the use of combination antiretroviral therapy in this population may further facilitate a shift in service provision and promote shared care between specialist centres, local hospitals and community-based services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III
Table IV
Table V

Similar content being viewed by others

References

  1. Rutstein RM, Feingold A, Meisleich D, et al. Protease inhibitor therapy in children with perinatally acquired HIV infection. AIDS 1997; 11: F107–11

    Article  Google Scholar 

  2. Samson LM, King SM, Asad S, et al. A prospective analysis of the immunologic and virologic responses to protease inhibitors in children [abstract 422]: Seventh Annual Canadian Conference on HIV/AIDS Research. Can J Infect Dis 1998; 9 Suppl. A: 63A

    Google Scholar 

  3. Postma MJ, EJ Beck, Mandalia S, et al. Universal HIV screening of pregnant women in England: cost-effectiveness analysis. BMJ 1999; 318: 1656–60

    Article  PubMed  CAS  Google Scholar 

  4. PHLS Communicable Disease Surveillance Centre. AIDS and HIV-1 infection in the United Kingdom: monthly report. Commun Dis Rep 1995; 5: 79–80

    Google Scholar 

  5. Boulton M, Pepper K, Walters S, et al. Getting on with life: the experience of families of children with HIV infection. In: Aggleton P, Hart G, Davies P, editors. Families and communities responding to AIDS. London: UCL Press, Taylor and Francis, 1999: 5–20

    Google Scholar 

  6. British Paediatric Surveillance Unit. Surveillance of paediatric HIV infection and AIDS. London: Department of Paediatric Epidemiology, Institute of Child Health, 1990

    Google Scholar 

  7. CDC Classification System for human immunodeficiency virus (HIV) infection in children under 13 years of age. MMWR Morb Mortal Wkly Rep 1987; 36: 225–31

    Google Scholar 

  8. NHS Executive. Hospital and community health services revenue (pay and prices) inflation index. Leeds: NHS Executive Finance and Performance Department A, 1997

    Google Scholar 

  9. Tolley K, Gyldmark M. Towards a standardized framework for costing HIV and AIDS treatment and care in Europe. In: Fitzsimons D, Hardy V, Tolley K, editors. The economic and social impact of AIDS in Europe. London: Cassell, 1995: 25–39

    Google Scholar 

  10. Gray A. Resourcing healthcare for AIDS and HIV infection in England, 1983–1993: uncertainty and hindsight. In: Fitzsimons D, Hardy V, Tolley K, editors. The economic and social impact of AIDS in Europe. London: Cassell, 1995: 119–31

    Google Scholar 

  11. Knapp M. Background theory. In: Netten A, Beecham J, editors. Costing community care: theory and practice. Aldershot: Ashgate Publishing Ltd, 1993: 9–24

    Google Scholar 

  12. Allen C, Beecham J. Costing services: ideals and reality. In: Netten A, Beecham J, editors. Costing community care: theory and practice. Aldershot: Ashgate Publishing Ltd, 1993: 25–42

    Google Scholar 

  13. Drummond MF, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 1986: 10–6

    Google Scholar 

  14. Wright KG. Cost-effectiveness in community care. York: Centre for Health Economics, University of York, 1987

    Google Scholar 

  15. Davies BP, Challis D. Matching resources to needs in community care. Aldershot: Gower, 1986

    Google Scholar 

  16. HIV and STD Division, Communicable Disease Surveillance Centre. AIDS/HIV Quarterly Surveillance Tables: UK data to the end December 1997. Colindale: Public Health Laboratory Service AIDS Centre, Feb 1998: Tables 17a and b

  17. Griffith R, Beck EJ, Beecham JK. Unit costs of services for HIV-infected children St. Mary’s Hospital, 1993–1994. London: Department of Epidemiology and Public Health, Imperial College School of Medicine at St. Mary’s, 1996

    Google Scholar 

  18. British National Formulary Number 25 (March 1993). London: British Medical Association and the Royal Pharmaceutical Society of Great Britain, 1993

  19. Netten A, editor. Unit Costs of Community Care Report 1994. Canterbury: Personal & Social Services Research Unit, University of Kent, 1994

    Google Scholar 

  20. Beck EJ, Griffith R, Mandalia S, et al. The hospital and community services study of families with HIV infection: use and cost of community service provision. London: Department of Epidemiology and Public Health, Imperial College School of Medicine at St. Mary’s, 1997

    Google Scholar 

  21. SAS/STAT User’s Guide. Version 6. 4th ed. Cary (NC): SAS Institute Inc., 1990

  22. Beck EJ, Kennelly J, McKevitt C, et al. Changing use of hospital services and costs at a London AIDS referral centre 1983–1989. AIDS 1994; 8: 367–77

    Article  PubMed  CAS  Google Scholar 

  23. Beck EJ, Tolley K, Power A, et al. Use and cost of HIV service provision in England, 1996. Pharmacoeconomics 1998; 14: 639–52

    Article  PubMed  CAS  Google Scholar 

  24. Parsonage M, Neuberger H. Discounting of health benefits. Health Econ 1992; 1: 71–6

    Article  PubMed  CAS  Google Scholar 

  25. Her Majesty’s Treasury. Economic appraisal in central government: a technical guide for government departments. London: HMSO, 1991

    Google Scholar 

  26. Beck EJ, Beecham J, Mandalia S, et al. What is the cost of getting the price wrong? J Public Health Med 1999; 21: 311–7

    Article  PubMed  CAS  Google Scholar 

  27. Finkler SA. The distinction between cost and charges. Ann Intern Med 1982; 96: 102–9

    PubMed  CAS  Google Scholar 

  28. Hegarty JD, Abrams EJ, Hutchinson VE, et al. Themedical care costs of human immunodeficiency virus-infected children in Harlem. JAMA 1988; 260: 1901–5

    Article  PubMed  CAS  Google Scholar 

  29. Conviser R, Grant CM, Coye MJ. Pediatric acquired immunodeficiency syndrome hospitalizations in New Jersey. Pediatrics 1991; 87: 642–53

    PubMed  CAS  Google Scholar 

  30. Hsia DC, Fleishman JA, East JA, et al. Pediatric human immunodeficiency virus infection. Arch Pediatr Adolesc Med 1995; 149: 489–96

    Article  PubMed  CAS  Google Scholar 

  31. Beck EJ, Mandalia S, Griffith R, et al. The Hospital and Community Services Study of Families with HIV Infection: initial analyses of hospital service provision and costs for HIV-infected children at St. Mary’s Hospital, 1986–1994. London: Department of Epidemiology and Public Health, Imperial College School of Medicine at St. Mary’s, 1997

    Google Scholar 

  32. Gibb D, Masters J, Shingadia D, et al. Afamily clinic: optimizing care for HIV infected children and their families. Arch Dis Child 1997; 77: 478–82

    Article  PubMed  CAS  Google Scholar 

  33. Andrews RM, Keyes MA, Fanning TR, et al. Lifetime Medicaid service utilization and expenditures for AIDS in New York and California. J AIDS 1991; 4: 1046–58

    CAS  Google Scholar 

  34. Collard A, Pizer C, Pearlman D, et al. Hospital based inpatient and outpatient resource use by children testing positive for HIV [abstract PoD-5701]. Proceedings of the Eighth International Conference on AIDS; 1992 Jul 19–24; Amsterdam

  35. Rodriguez MD, Torres L, Diaz C, et al. Inpatient resource utilization by a pediatric AIDS patient population at a public teaching hospital [abstract PO-D34–4310]. Proceedings of the Ninth International Conference on AIDS; 1993 Jun 6–11; Berlin

  36. Fahs MC, Waite D, Sesholtz M, et al. Results of the ACSUS for Pediatric AIDS patients: utilization of services, functional status and social services. Health Serv Res 1994; 29: 549–68

    PubMed  CAS  Google Scholar 

  37. Sculpher M, Gibb D, Ades AE, et al. Modelling the costs of paediatric HIV infection and AIDS: comparison of infected children born to screened and unscreened mothers. AIDS 1998; 12: 1371–80

    Article  PubMed  CAS  Google Scholar 

  38. Carlin JB, Langdon P, Hurley SF, et al. Health care and its costs for children with perinatally acquired HIV infection. J Paediatr Child Health 1996; 32: 42–7

    Article  PubMed  CAS  Google Scholar 

  39. Havens PL, Cuene BE, Holtgrave D. Lifetime cost of care for children with human immunodeficiency virus infection. Pedriatr Infect Dis J 1997; 16: 607–10

    Article  CAS  Google Scholar 

  40. Henderson J, Goldacre M, Griffith M. Time spent in hospital by children: trends in the Oxford Record Linkage Study area. Health Trends 1990/91; 4: 166–9

    Google Scholar 

  41. Beck EJ, Pozniak A, Molesworth A, et al. Changing cost of English HIV service provision 1996–1997. Int J STD AIDS 1999; 10: 357–62

    Article  Google Scholar 

  42. Dunn DT, Newell ML, Ades AE, et al. Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet 1992; 340: 585–8

    Article  PubMed  CAS  Google Scholar 

  43. European Collaborative Study. Caesarean section and risk of vertical transmission of HIV-1 infection. Lancet 1994; 343: 1464–7

    Article  Google Scholar 

  44. Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 1994; 331: 1173–80

    Article  PubMed  CAS  Google Scholar 

  45. McIntosh K. Short (and shorter) courses of zidovudine. N Engl J Med 1998; 339: 1467–8

    Article  PubMed  CAS  Google Scholar 

  46. Direction des Hospitaux, Mission SIDA. DMI2: an information system built around the patient. Paris: INSERM-SC4, Ministere de la Sante et de l’action Humanitaire, 1993

  47. Beck EJ. Counting the cost of HIV service provision in England: where do we go from here? J HIV Comb Ther 1997; 2: 29–32

    Google Scholar 

Download references

Acknowledgements

The authors would like to thank the staff and patients of the Department of Paediatrics (Imperial College School of Medicine, London, England), the Finance and the Information Department at St. Mary’s Hospital (London, England), the business managers of other relevant departments involved with paediatric care at St. Mary’s Hospital, staff of the Funding Agency for Schools, the National Childminding Association and members of all other community organisations for providing assistance during the study. We are particularly indebted to Jo Dodge, Angela Bowman, Jennifer Evans, Katy Pepper, Mary Egan and Stavros Petrou for assistance with data collection and analysis.

This study was funded by the Department of Health of England and Wales. There was no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eduard J. Beck.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beck, E.J., Mandalia, S., Griffith, R. et al. Use and Cost of Hospital and Community Service Provision for Children with HIV Infection at an English HIV Referral Centre. Pharmacoeconomics 17, 53–69 (2000). https://doi.org/10.2165/00019053-200017010-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-200017010-00004

Keywords

Navigation