1
|
Shaaban AN, Peleteiro B, Martins MRO. Statistical models for analyzing count data: predictors of length of stay among HIV patients in Portugal using a multilevel model. BMC Health Serv Res 2021; 21:372. [PMID: 33882911 PMCID: PMC8061202 DOI: 10.1186/s12913-021-06389-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 04/14/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND This study offers a comprehensive approach to precisely analyze the complexly distributed length of stay among HIV admissions in Portugal. OBJECTIVE To provide an illustration of statistical techniques for analysing count data using longitudinal predictors of length of stay among HIV hospitalizations in Portugal. METHOD Registered discharges in the Portuguese National Health Service (NHS) facilities Between January 2009 and December 2017, a total of 26,505 classified under Major Diagnostic Category (MDC) created for patients with HIV infection, with HIV/AIDS as a main or secondary cause of admission, were used to predict length of stay among HIV hospitalizations in Portugal. Several strategies were applied to select the best count fit model that includes the Poisson regression model, zero-inflated Poisson, the negative binomial regression model, and zero-inflated negative binomial regression model. A random hospital effects term has been incorporated into the negative binomial model to examine the dependence between observations within the same hospital. A multivariable analysis has been performed to assess the effect of covariates on length of stay. RESULTS The median length of stay in our study was 11 days (interquartile range: 6-22). Statistical comparisons among the count models revealed that the random-effects negative binomial models provided the best fit with observed data. Admissions among males or admissions associated with TB infection, pneumocystis, cytomegalovirus, candidiasis, toxoplasmosis, or mycobacterium disease exhibit a highly significant increase in length of stay. Perfect trends were observed in which a higher number of diagnoses or procedures lead to significantly higher length of stay. The random-effects term included in our model and refers to unexplained factors specific to each hospital revealed obvious differences in quality among the hospitals included in our study. CONCLUSIONS This study provides a comprehensive approach to address unique problems associated with the prediction of length of stay among HIV patients in Portugal.
Collapse
Affiliation(s)
- Ahmed Nabil Shaaban
- Department of Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Rua da Junqueira N°100, 1349-008, Lisbon, Portugal.
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
| | - Bárbara Peleteiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Maria Rosario O Martins
- Department of Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Rua da Junqueira N°100, 1349-008, Lisbon, Portugal
| |
Collapse
|
2
|
Agudelo CA, Álvarez MF, Hidrón A, Villa JP, Echeverri-Toro LM, Ocampo A, Porras GP, Trompa IM, Restrepo L, Eusse A, Restrepo CA. Outcomes and complications of hospitalised patients with HIV-TB co-infection. Trop Med Int Health 2020; 26:82-88. [PMID: 33155342 DOI: 10.1111/tmi.13509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tuberculosis is one of the most common causes of hospitalisation in patients with HIV. Despite this, hospital outcomes of patients with this co-infection have rarely been described since antiretroviral therapy became widely available. METHODS Prospective cohort study of HIV-infected adult patients hospitalised with TB in six referral hospitals in Medellin, Colombia, from August 2014 to July 2015. RESULTS Among 128 HIV-infected patients hospitalised with tuberculosis, the mean age was 38.4 years; 79.7% were men. HIV was diagnosed on admission in 28.9% of patients. The median CD4 + T-cell count was 125 (±158 SD) cells/µL. Only 47.3% of patients with a known diagnosis of HIV upon admission were on antiretroviral therapy, and only 11.1% had a tuberculin skin test in the previous year. Drug toxicity due to tuberculosis medications occurred in 11.7% of patients. Mean length of stay was 23.2 days, and 10.7% of patients were readmitted. Mortality was 5.5%. CONCLUSIONS Hospital mortality attributable to tuberculosis in patients with HIV is low in reference hospitals in Colombia. Cases of tuberculosis in HIV-infected patients occur mainly in patients with advanced HIV, or not on antiretroviral therapy, despite a known diagnosis of HIV. Only one of every 10 patients in this cohort had active screening for latent tuberculosis, possibly reflecting missed treatment opportunities.
Collapse
Affiliation(s)
- Carlos Andrés Agudelo
- Universidad Pontificia Bolivariana, Medellín.,Clínica Universitaria Bolivariana, Medellín, Colombia.,Hospital San Vicente de Paúl, Rionegro, Colombia
| | | | - Alicia Hidrón
- Universidad Pontificia Bolivariana, Medellín.,Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Juan Pablo Villa
- Universidad Pontificia Bolivariana, Medellín.,IPS Universitaria Clínica León XIII, Medellín, Colombia
| | - Lina María Echeverri-Toro
- Hospital San Vicente de Paúl, Rionegro, Colombia.,Hospital Universitario, San Vicente Fundación, Medellín, Colombia
| | | | | | - Iván Mauricio Trompa
- Universidad Pontificia Bolivariana, Medellín.,IPS Universitaria Clínica León XIII, Medellín, Colombia
| | | | | | - Carlos Andrés Restrepo
- Universidad Pontificia Bolivariana, Medellín.,IPS Universitaria Clínica León XIII, Medellín, Colombia
| |
Collapse
|
3
|
Pontali E, Ranieri R, Rastrelli E, Iannece MD, Ialungo AM, Dell'Isola S, Liberti A, Rosario P, Casati R, Starnini G, Babudieri S. Hospital admissions for HIV-infected prisoners in Italy. Int J Prison Health 2018; 13:105-112. [PMID: 28581372 DOI: 10.1108/ijph-02-2016-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose The purpose of this paper is to give a description of the clinical conditions and patient demographics of inpatient admissions of human immunodeficiency virus (HIV)-infected inmates in three hospital wards that provide hospital care for inmates in Italy. Design/methodology/approach This is a retrospective review of hospital medical admissions of patients living with HIV from January 1 to December 31, 2014, in three Italian referral centers for hospitalization of inmates. Findings A total of 85 admissions for 85 different HIV-infected inmates occurred in 2014 in the three centers participating to the study. Most patients (54.1 percent) were co-infected with hepatitis C. Discharge diagnosis largely varied ranging from common HIV-related co-morbidities to completely independent diagnosis. The most commonly observed discharge diagnoses were chronic hepatitis C, liver cirrhosis, opiate dependence and thrombocytopenia. Originality/value Discharge diagnosis between HIV-infected inmates and HIV-infected patients in freedom are strikingly and significantly different. A large number of hospitalized HIV-infected inmates were affected by chronic viral hepatitis and liver cirrhosis; this is probably a direct consequence of the high prevalence of HCV and/or HBV co-infections in the inmate population in Italy. In addition, a significantly lower proportion of cancer diagnosis was observed among inmates; this is possibly justified by the fact that in our Italian settings when HIV infection is at advanced stages or if cancer treatment is started those affected are released from prison and can continue their diagnostic and treatment follow-up in freedom.
Collapse
Affiliation(s)
- Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Roberto Ranieri
- Department of Internal Medicine, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Elena Rastrelli
- Medicina Protetta-malattie Infettive, Ospedale di Belcolle, Viterbo, Italy
| | | | | | | | | | | | | | - Giulio Starnini
- Unit Medicina Protetta-Malattie Infettive, Ospedale di Belcolle, Viterbo, Italy
| | - Sergio Babudieri
- Facolta di Medicina e Chirurgia, Universita degli Studi di Sassari , Sassari, Italy
| |
Collapse
|
4
|
Mahlab-Guri K, Asher I, Bezalel-Rosenberg S, Elbirt D, Sthoeger ZM. Hospitalizations of HIV patients in a major Israeli HIV/AIDS center during the years 2000 to 2012. Medicine (Baltimore) 2017; 96:e6812. [PMID: 28471983 PMCID: PMC5419929 DOI: 10.1097/md.0000000000006812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
To evaluate hospitalization rates and causes among human immunodeficiency virus (HIV) patients in the late highly active antiretroviral therapy (HAART) era. Data during the years 2000 to 2012 were obtained from hospital/clinical charts. Hospitalizations were defined as a ≥24 hours hospital admission. Obstetric admissions were excluded. Causes of hospitalizations were defined as acquired immune deficiency syndrome (AIDS)-defining illnesses, AIDS-related diseases (HAART adverse events, metabolic complications and non-AIDS-defining tumors/infections), and non-HIV-related diseases. Hospitalization rates are presented as admissions per 100 patient years. The number of HIV patients (58% males) in our center increased from 521 in 2000 to 1169 in 2012. 1676 hospital admissions (in 557 patients) were observed during the years of the study. The mean number of admissions per hospitalized patient was 3 ± 3.39. Hospitalization rates of HIV patients declined significantly (18.4/100 in 2000, 9/100 patient years in 2012; P = .0001), but it was higher than the rates reported in the Israeli general population (X8.76 in 2000, X6.04 in 2012). Furthermore, hospitalizations for AIDS-defining illness declined (from 46.9% to 16.1%) whereas non-HIV-related hospitalizations increased (from 31.3% to 60.1%). Lower cluster of differentiation 4 (CD4) cell counts and older age, at the time of HIV diagnosis, were associated with higher rates of admissions (especially for AIDS-defining illnesses) and mortality. Hospitalization rates of HIV patients, especially for AIDS-defining illness, continue to decline in the late HAART era despite the increasing age of the patients, though it is still higher than that of the general population. Low CD4 cell counts and older age, at the time of HIV diagnosis, are associated with readmissions and mortality.
Collapse
|
5
|
Cenderello G, Artioli S, Viscoli C, Pasa A, Giacomini M, Giannini B, Dentone C, Nicolini LA, Cassola G, Di Biagio A. Budget impact analysis of sofosbuvir-based regimens for the treatment of HIV/HCV-coinfected patients in northern Italy: a multicenter regional simulation. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 8:15-21. [PMID: 26770065 PMCID: PMC4706121 DOI: 10.2147/ceor.s93641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objectives Chronic hepatitis C virus (HCV) is a leading cause of hospitalization and death in populations coinfected with human immunodeficiency virus (HIV). Sofosbuvir (SOF) is a pan-genotypic drug that should be combined with other agents as an oral treatment for HCV. We performed a 5-year horizon budget impact analysis of SOF-based regimens for the management of HIV/HCV-coinfected patients. Methods A multicenter, prospective evaluation was conducted, involving four Italian Infectious Diseases Departments (Galliera, San Martino, Sanremo, and La Spezia). All 1,005 genotype-coinfected patients (30% cirrhotics) under observation were considered (patients in all disease-stages were considered: chronic hepatitis C, cirrhosis, transplant, hepatocellular carcinoma). Disease stage costs per patient were collected; the expected disease progression in the absence of treatment and sustained virological response (SVR) success rate for SOF-based regimens were calculated based on the literature and expert opinion. Drug prices were based on what the National Health Service paid for them. The comparison of “no treatment” disease progression costs versus the economic impact of SOF-based regimens was investigated. Results Over the following 5 years, the disease progression scenario resulted in direct costs of approximately €54 million. Assuming an SVR success rate of 90%, average SOF-based regimens cost up to €50,000 per person, resulting in a final cost of more than €56 million, so this option is not economically viable. At the average price of €12,000, SOF-based regimens, expense was €17 million, saving 68%. At this price level, the economic resources invested in treating mild to moderate fibrosis stage patients would be equal to the amount of direct costs of disease management in this stage, resulting in a valid return of investment in the short-term. Conclusion Given the high rates of SVR, in the Italian Healthcare System, SOF-based regimens, price is a determinant and a predictor of the overall cost for the Hepatitis C patient’s management. At the average price per therapy of €12,000 over the next 5 years, SOF-based regimens are becoming highly sustainable.
Collapse
Affiliation(s)
| | | | - Claudio Viscoli
- Infectious Diseases Unit, A San Martino, IST, Genoa University, Genoa, Italy
| | - Ambra Pasa
- IT Unit, Ospedali Galliera, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genova, Italy
| | - Barbara Giannini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genova, Italy
| | - Chiara Dentone
- Infectious Diseases Unit, ASL-1 Imperiese, Sanremo, Imperia, Italy
| | | | | | - Antonio Di Biagio
- Infectious Diseases Unit, A San Martino, IST, Genoa University, Genoa, Italy
| |
Collapse
|