title: Prediction of higher cost of antiretroviral therapy (ART) according to clinical complexity. A validated clinical index.
abstract: BACKGROUND
  The financing of antiretroviral therapy (ART) is generally determined by the cost incurred in the previous year, the number of patients on treatment, and the evidence-based recommendations, but not the clinical characteristics of the population.
  
  
  OBJECTIVE
  To establish a score relating the cost of ART and patient clinical complexity in order to understand the costing differences between hospitals in the region that could be explained by the clinical complexity of their population.
  
  
  METHODS
  Retrospective analysis of patients receiving ART in a tertiary hospital between 2009 and 2011. Factors potentially associated with a higher cost of ART were assessed by bivariate and multivariate analysis. Two predictive models of "high-cost" were developed. The normalized estimated (adjusted for the complexity scores) costs were calculated and compared with the normalized real costs.
  
  
  RESULTS
  In the Hospital Index, 631 (16.8%) of the 3758 patients receiving ART were responsible for a "high-cost" subgroup, defined as the highest 25% of spending on ART. Baseline variables that were significant predictors of high cost in the Clinic-B model in the multivariate analysis were: route of transmission of HIV, AIDS criteria, Spanish nationality, year of initiation of ART, CD4+ lymphocyte count nadir, and number of hospital admissions. The Clinic-B score ranged from 0 to 13, and the mean value (5.97) was lower than the overall mean value of the four hospitals (6.16).
  
  
  CONCLUSIONS
  The clinical complexity of the HIV patient influences the cost of ART. The Clinic-B and Clinic-BF scores predicted patients with high cost of ART and could be used to compare and allocate costs corrected for the patient clinical complexity.
authors: Preventive Medicine and Epidemiology Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain. Electronic address: velascomunoz@gmail.com.
authors: Cesar
authors: C
authors: Velasco
authors: Infectious Disease and HIV Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors: Inaki
authors: I
authors: Pérez
authors: HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain.
authors: Daniel
authors: D
authors: Podzamczer
authors: HIV Unit and "Lluita contra la SIDA" Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain.
authors: Josep Maria
authors: JM
authors: Llibre
authors: Infectious Disease and HIV Service, Hospital Sant Pau, Spain.
authors: Pere
authors: P
authors: Domingo
authors: Infectious Disease and HIV Service, Hospital La Paz, Spain.
authors: Juan
authors: J
authors: González-García
authors: Administration and Economics, Internal Medicine and Dermatology Institute, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors: Inma
authors: I
authors: Puig
authors: Administration and Economics, Internal Medicine and Dermatology Institute, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors: Pilar
authors: P
authors: Ayala
authors: Hospital Pharmacy Service, Hospital Clínic de Barcelona, Spain.
authors: Mayte
authors: M
authors: Martín
authors: Preventive Medicine and Epidemiology Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors: Antoni
authors: A
authors: Trilla
authors: Técnicas Avanzadas de Investigación en Servicios de Salud, Madrid, Spain.
authors: Pablo
authors: P
authors: Lázaro
authors: Infectious Disease and HIV Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors: Josep Maria
authors: JM
authors: Gatell
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics*; D018791:CD4 Lymphocyte Count; D003365:Costs and Cost Analysis; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D012189:Retrospective Studies
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; Costos y análisis de costo; Costs and cost analysis; Decision support techniques; HIV; Highly active antiretroviral therapy; Logistic models; Modelos logísticos; SIDA; Terapia antirretroviral; Técnicas gestión; VIH