Expenditures for the care of HIV-infected patients in rural areas in China's antiretroviral therapy programs

BMC Medicine

Research Article

Song Duan¹  Gerald F Kominski²  Jiansheng Wang³  Han-Zhu Qian⁴  Zhiwei Guo⁵  Feng Zhou⁶  Xinping Zhao⁷ 

[1] Center for Disease Control, Dehong Dai and Jingpo Autonomous Region, Yunnan Province, P.R. China;Center for Health Policy Research, University of California, Los Angeles, California, USA;Center for Public Health Surveillance and Information Service, Chinese Center for Disease Control and Prevention, Beijing, P.R. China;Institute for Global Health and Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA;School of Public Health, Peking Union Medical College, Beijing, P.R. China;State Key Laboratory for Molecular Virology and Genetic Engineering, Institute of Pathogen Biology, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, P.R. China;Wenxi County Hospital, Wenxi County, Shanxi Province, P.R. China;

关键词: Human Immunodeficiency Virus;    Human Immunodeficiency Virus Viral Load;    Human Immunodeficiency Virus Treatment;    Village Clinic;    Peripheral Neuritis;   

DOI  :  10.1186/1741-7015-9-6

 received in 2010-10-29, accepted in 2011-01-17,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundThe Chinese government has provided health services to those infected by the human immunodeficiency virus (HIV) under the acquired immunodeficiency syndrome (AIDS) care policy since 2003. Detailed research on the actual expenditures and costs for providing care to patients with AIDS is needed for future financial planning of AIDS health care services and possible reform of HIV/AIDS-related policy. The purpose of the current study was to determine the actual expenditures and factors influencing costs for untreated AIDS patients in a rural area of China after initiating highly active antiretroviral therapy (HAART) under the national Free Care Program (China CARES).MethodsA retrospective cohort study was conducted in Yunnan and Shanxi Provinces, where HAART and all medical care are provided free to HIV-positive patients. Health expenditures and costs in the first treatment year were collected from medical records and prescriptions at local hospitals between January and June 2007. Multivariate linear regression was used to determine the factors associated with the actual expenditures in the first antiretroviral (ARV) treatment year.ResultsFive ARV regimens are commonly used in China CARES: zidovudine (AZT) + lamivudine (3TC) + nevirapine (NVP), stavudine (D4T) + 3TC + efavirenz (EFV), D4T + 3TC + NVP, didanosine (DDI) + 3TC + NVP and combivir + EFV. The mean annual expenditure per person for ARV medications was US$2,242 (US$1 = 7 Chinese Yuan (CNY)) among 276 participants. The total costs for treating all adverse drug events (ADEs) and opportunistic infections (OIs) were US$29,703 and US$23,031, respectively. The expenses for treatment of peripheral neuritis and cytomegalovirus (CMV) infections were the highest among those patients with ADEs and OIs, respectively. On the basis of multivariate linear regression, CD4 cell counts (100-199 cells/μL versus <100 cells/μL, P = 0.02; and ≥200 cells/μL versus <100 cells/μL, P < 0.004), residence in Mangshi County (P < 0.0001), ADEs (P = 0.04) and OIs (P = 0.02) were significantly associated with total expenditures in the first ARV treatment year.ConclusionsThis is the first study to determine the actual costs of HIV treatment in rural areas of China. Costs for ARV drugs represented the major portion of HIV medical expenditures. Initiating HAART in patients with higher CD4 cell count levels is likely to reduce treatment expenses for ADEs and OIs in patients with AIDS.

【 授权许可】

CC BY   
© Zhou et al; licensee BioMed Central Ltd. 2011