The High Cost of HIV-Positive Inpatient Care at an Urban Hospital in Johannesburg, South Africa
BACKGROUND:
While
most HIV care is provided on an outpatient basis, hospitals continue to treat
serious HIV-related admissions, which is relatively resource-intensive and
expensive. This study reports the primary reasons for HIV-related admission at
a regional, urban hospital in Johannesburg, South Africa and estimates the
associated lengths of stay and costs.
METHODS AND FINDINGS:
A
retrospective cohort study of adult, medical admissions was conducted. Each
admission was assigned a reason for admission and an outcome. The length of
stay was calculated for all patients (N = 1,041) and for HIV-positive patients
(n = 469), actual utilization and associated costs were also estimated. Just
under half were known to be HIV-positive admissions. Deaths and transfers were
proportionately higher amongst HIV-positive admissions compared to HIV-negative
and unknown. The three most common reasons for admission were tuberculosis and
other mycobacterial infections (18%, n = 187), cardiovascular disorders (12%, n
= 127) and bacterial infections (12%, n = 121). The study sample utilized a
total of 7,733 bed days of those, 55% (4,259/7,733) were for HIV-positive
patients. The average cost per admission amongst confirmed HIV-positive
patients, which was an average of 9.3 days in length, was $1,783 (United States
Dollars).
CONCLUSIONS:
Even
in the era of large-scale antiretroviral treatment, inpatient facilities in
South Africa shoulder a significant HIV burden. The majority of this burden is
related to patients not on ART (298/469, 64%), and accounts for more than half
of all inpatient resources. Reducing the costs of inpatient care is thus
another important benefit of expanding access to ART, promoting earlier ART initiation,
and achieving rates of ART retention and adherence.
Below: Summary of reasons for admission by HIV status
By: Long LC1,2,3, Fox MP1,2,3,4,5, Sauls C1,3, Evans D1,2,3, Sanne I1,2,3,4, Rosen SB1,3,4.
- 1Department of Internal Medical, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
- 2School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
- 3Health Economics and Epidemiology Research Office, Wits Health Consortium, Johannesburg, South Africa.
- 4Center for Global Health & Development, Boston University, Boston, Massachusetts, United States of America.
- 5Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America.
- PLoS One. 2016 Feb 17;11(2):e0148546. doi: 10.1371/journal.pone.0148546. eCollection 2016.
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