Pediatric human immunodeficiency virus infection. Recent evidence on the utilization and costs of health services

D. C. Hsia, J. A. Fleishman, J. A. East and F. J. Hellinger
Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, Rockville, MD, USA.

OBJECTIVE: To measure the utilization and costs of pediatric human immunodeficiency virus (HIV)-related health care services. DESIGN: Cohort survey. SETTING: Eight outpatient departments serving large numbers of HIV-infected children in five standard metropolitan areas with high prevalence of HIV-infected children. PATIENTS: One hundred forty-one HIV-seropositive children older than 15 months of age or children whose clinical conditions meet the definition of acquired immunodeficiency syndrome (AIDS) at any age who visited the selected providers during the second quarter of 1991. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Quarterly interview survey (via adult proxies) of health care services utilization during each preceding 3-month period, repeated six times between March 1991 and August 1992. Charge data were abstracted from inpatient, outpatient, home health care, and pharmacy bills. RESULTS: Children with AIDS averaged 1.4 hospitalizations, 16 inpatient days, two emergency department visits, 18 ambulatory care visits, 15 professional home health care visits, and one dental visit per year, generating an estimated $37,928 in annual charges. The HIV-infected children used fewer services, with annual charges of $9382. CONCLUSIONS: We found lower utilization than reported in prior research on pediatric HIV and similar unit costs after inflation adjustment. Increasing experience in clinical management and expanded ambulatory care may have contributed to reductions in inpatient services utilization and total costs since the mid-1980s.

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