title: The impact of prophylaxis on outcome and resource utilization in Pneumocystis carinii pneumonia.
abstract: OBJECTIVE
  Pneumocystis carinii pneumonia (PCP) is a major late complication of HIV infection associated with morbidity and mortality. Because chemoprophylaxis is highly effective, cases of PCP can be viewed as failures in the management of HIV disease.
  
  
  METHODS
  We reviewed demographic, clinical, and cost data for all cases of confirmed HIV-related PCP at The Johns Hopkins Hospital in 1991 to determine consequences of missed prophylaxis. We also analyzed hospital discharge data for Maryland in 1991 to assess hospital charges, length of stay, and outcome for all patients with a principal diagnosis of HIV-related PCP.
  
  
  RESULTS
  Pneumocystis carinii pneumonia was diagnosed in 79 patients. Of the 79 patients, 61 (77%) did not receive prophylaxis, including 26 who were not previously known to have HIV infection, 17 who did not have prophylaxis prescribed, and 18 who had prophylaxis prescribed, but were not compliant with the regimen. Patients not taking prophylaxis accounted for all 12 deaths ascribed to PCP. This group also accounted for 85% of the hospital days, 100% of the ICU days, and 89% of the inpatient charges. The total hospital charges were $849,540. Extrapolation of these figures for the state of Maryland suggest that the failure to receive prophylaxis in 1991 resulted in 62 patient deaths and a cost of approximately $4.7 million.
  
  
  CONCLUSIONS
  Patients who developed PCP despite prophylaxis had a better outcome and used fewer resources than patients not receiving preventive therapy. This study emphasizes the impact of PCP prophylaxis on the morbidity, mortality, and economics of HIV health care.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Gallant
authors.forename: S M
authors.initials: SM
authors.lastname: McAvinue
authors.forename: R D
authors.initials: RD
authors.lastname: Moore
authors.forename: J G
authors.initials: JG
authors.lastname: Bartlett
authors.forename: D L
authors.initials: DL
authors.lastname: Stanton
authors.forename: R E
authors.initials: RE
authors.lastname: Chaisson
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D015142:Baltimore; D017281:Cost of Illness; D005260:Female; D017722:Hospital Charges; D006785:Hospitals, University / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014600:Utilization Review