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The impact of new drug therapies on the longevity and progression of HIV disease has been dramatic. As a result, today HIV disease may be thought of as a moderately expensive chronic disease rather than as a catastrophically expensive fatal illness. A recent study carried out by Fred J. Hellinger, Ph.D., of the Agency for Healthcare Research and Quality, showed a substantial decline in HIV-related hospitalizations in eight States from 1996 to 2000. In these States, where more than 52 percent of AIDS patients were living at the time, HIV-related hospitalizations declined from 114,885 in 1996 to 77,694 in 2000.
The State in which an HIV patient was hospitalized was a more important determinant of the length and cost of hospital stay than hospital characteristics or the patient's age, race, sex, insurance status, or number of diagnoses, according to Dr. Hellinger. For example, among people hospitalized with HIV, those in New York had the longest average hospital stay (12.4 days in 1996 and 10 days in 2000). The shortest length of stay in both 1996 and 2000 was in Colorado (6 days in 1996 and 6.3 days in 2000). The mean cost of a hospital stay was $15,037 in the six States for which cost data were available. The cost of a hospital visit for an HIV patient in California was $2,979 less than for a similar patient in New York, and the cost was $2,942 less for those in New Jersey than for similar HIV patients in New York.
Also, Florida had 11 percent fewer and South Carolina had 13 percent fewer HIV-related hospitalizations between 1996 and 2000. Both of these States had highly restrictive AIDS Drug Assistance Programs (ADAPs). During the same period, HIV-related hospitalizations were reduced by 42 percent in New York, 39 percent in Pennsylvania, and 35 percent in New Jersey, all States with liberal ADAPs.
For the study, Dr. Hellinger used hospital data obtained from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID), which is maintained by AHRQ. The HCUP contains hospital discharge data and represents a Federal/State/industry partnership to build a multi-State health care data system.
See "HIV patients in the HCUP database: A study of hospital utilization and costs," by Dr. Hellinger, in the Spring 2004 Inquiry 41, pp. 95-105.
Reprints (AHRQ Publication No. 04-R060) are available from the AHRQ Publications Clearinghouse.
Editor's Note: An AHRQ-supported study on a related topic found that a multicenter quality improvement collaborative did not significantly affect the quality of care for nearly 10,000 patients with HIV disease. For more details, see Landon, B.E., Wilson, I.B., McInnes, K., and others. (2004, June). "Effects of a quality improvement collaborative on the outcome of care of patients with HIV infection: the EQHIV study." (AHRQ grant HS10227). Annals of Internal Medicine 140, pp. 887-896.
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