The High Cost of HIV-Positive Inpatient Care at an Urban Hospital in Johannesburg, South Africa

• Published in: PloS one 2016-02, Vol.11 (2), p.e0148546-e0148546
• Main Authors: Long, Lawrence C, Fox, Matthew P, Sauls, Celeste, Evans, Denise, Sanne, Ian, Rosen, Sydney B
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Adults; Aged; AIDS; Antiretroviral agents; Antiretroviral drugs; Bacteria; Biology and Life Sciences; Care and treatment; CD4 Lymphocyte Count; Clinical medicine; Cohort Studies; Complications and side effects; Consortia; Costs; Drug therapy; Economic aspects; Epidemiology; Female; Health aspects; Health Care Costs; Health economics; Health sciences; HIV; HIV infections; HIV Infections - economics; HIV Infections - epidemiology; Hospital patients; Hospitalization - economics; Hospitals; Hospitals, Urban - economics; Human immunodeficiency virus; Humans; Infections; Inpatients; Length of Stay; Male; Medical diagnosis; Medicine; Medicine and Health Sciences; Middle Aged; Patients; Public health; Public sector; South Africa - epidemiology; Studies; Tuberculosis; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0148546

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. 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). 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.