AIDS: costs of care in the developed and the developing world.

The costs of care for AIDS patients in developed and developing countries, expressed in patient-years and in patient lifetimes, as well as by total national costs are analyzed here. In industrialized countries, known as WHO Pattern I countries, the costs of AIDS care is generally proportional to GNP, and has been declining as caregivers learn how to manage the disease. Much of the decline is due to less intensive hospital care and more ambulatory care. Although the U.S. has the highest number of AIDS cases, the countries with the highest rate of disease are Canada (59.2/million), Australia (48.1) and New Zealand (22.4). In the U.S. 92% of patients are male, and 87% are 20-49 years old. In Pattern II countries, the sex ratio is less than 2.0. Cost information is very sparse, especially for children. Some representative lifetime costs for Pattern I countries are $19,000-147,000 in the U.S., $21,000 in France, $40,200 in Germany, $13,400-46,000 in U.K., and $15,800 in Australia. Costs per person-year are generally comparable, depending on whether hospitalization is more or less common in given countries. In the developing world, expenditures are much lower, because of the limited budget for health care available. Although costs tend to be in line with a country's GNP, costs are expected to become more standardized in the future as clinical experience with AIDS treatment increases and costing methodology becomes more uniform. Estimates of AIDS treatment costs for the U.S. in the near future range widely, but range from 1% to 3.3% of the total personal health-care expenditures of the nation. An estimate for Australia predicts $58.5 million by 1991, including hospital expenses only. None of the available costs estimates even deal with the costs of managing HIV-infected persons who have not developed AIDS. Needs in cost estimation methodology are discussed.