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


METHODS
A 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.


RESULTS
Five 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.


CONCLUSIONS
This 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.
Institute of Pathogen Biology, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, PR China. maple23@hotmail.com
Feng
F
Zhou
Gerald F
GF
Kominski
Han-Zhu
HZ
Qian
Jiansheng
J
Wang
Song
S
Duan
Zhiwei
Z
Guo
Xinping
X
Zhao
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000191:economics; D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000191:economics*; D002681:China; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012424:Rural Population; D016896:Treatment Outcome; D055815:Young Adult
J Int Assoc Physicians AIDS Care (Chic). 2007 Jun;6(2):83-6
17537997
Ann Intern Med. 2009 Aug 18;151(4):241-51, W-52
19687491
Clin Infect Dis. 2006 Apr 1;42(7):1003-10
16511767
Clin Infect Dis. 2008 Sep 15;47(6):825-33
18690805
Clin Infect Dis. 2008 Mar 15;46(6):933-40
18271750
HIV Clin Trials. 2005 Nov-Dec;6(6):302-11
16452064
N Engl J Med. 2006 Sep 14;355(11):1141-53
16971720
J Acquir Immune Defic Syndr. 2004 Jul 1;36(3):808-16
15213564
Zhonghua Liu Xing Bing Xue Za Zhi. 2005 Jul;26(7):507-10
16335002
N Engl J Med. 2001 Mar 15;344(11):817-23
11248159
AIDS. 1999 Oct 1;13(14):1933-42
10513653
N Engl J Med. 1998 Mar 26;338(13):853-60
9516219
J Acquir Immune Defic Syndr. 2009 Apr 1;50(4):390-6
19214120
N Engl J Med. 1999 Feb 4;340(5):367-73
9929528
N Engl J Med. 1992 Jan 23;326(4):231-5
1345800
Rev Soc Bras Med Trop. 2004 Jan-Feb;37(1):46-50
15042183
Health Policy. 2005 Nov;74(3):304-13
16226140
AIDS. 2006 Jun 26;20(10):1429-35
16791018
HIV Med. 2008 Jan;9(1):14-8
18199168
AIDS Care. 2006 Feb;18(2):121-7
16338769
PLoS One. 2008;3(12):e3918
19081791
Eur J Med Res. 2008 Jul 28;13(7):343-8
18700192
N Engl J Med. 1997 May 22;336(21):1531-2
9157292
Lancet. 2008 Jul 26;372(9635):293-9
18657708
Int J Epidemiol. 2010 Aug;39(4):973-9
19556327
Int J Epidemiol. 2008 Dec;37(6):1287-96
18922804
J Acquir Immune Defic Syndr. 2003 Nov 1;34(3):281-8
14600572