Iskudubka Xidhiidhka u dhexeeya Daryeelka Kharashka iyo Tayada
Qaar badan oo daraasadihii dhowaa ma eegin oo kaliya qiimaha nololeed ee daaweynta HIV laakiin waxtarkeeda kharashka inta lagu jiro xaaladaha kala duwan ee cudurka.
Mid ka mid ah daraasaddan oo ka timid Xarumaha Xakamaynta iyo Ka Hortagga Cudurrada Maraykanka (CDC) ayaa loogu talagalay in lagu qiyaaso celceliska nolosha kharashka HIV-labadaba labada qof ee bilaaba daaweynta antiretroviral therapy (ART) goor hore ( tirada CD4 ee 500 unug / mL ama ka yar) (200 unug / mL ama ka yar).
Natiijooyinku waxay xaqiijiyeen in cilmi-baadhisyo yar yar ay soo jeediyeen: in horay loo bilaabo ART ay la xiriirto qiime dhimista nolosha.
Sida laga soo xigtay cilmibaarista, ee loogu talagalay dadka bilaabaya daaweynta CD4-ga sare, qiyaasta celcelis ahaan nolosha kharashka waa qiyaas ahaan $ 250,000. Taas bedelkeeda, kuwa laga bilaabo 200 unug / mL ama ka yar waxay u badan tahay inay laba jeer qaataan lacagtaan - meel kasta oo u dhaxaysa $ 400,000 iyo $ 600,000.
Sababo ka mid ah sababaha loogu talagalay kharashka sarreeya ayaa ah khatarta sii kordheysa ee HIV-ga iyo HIV-ga la xidhiidha kuwa leh habdhiska difaaca jirka. Waxaa intaa dheer, suurtogalnimada in qofku awood u yeesho inuu dib u soo celiyo dhaqdhaqaaqa difaaca heerarka caadiga ah (sida, CD4 oo tiradoodu tahay 500-800 unug / mL) ayaa u muuqda in uu yaraynayo marka dambe ee daaweynta.
Falanqaynta dib-u-celinta ka timid Weill Cornell Medical College ayaa sidoo kale taageertey gabagabadii. raadinta shakhsiyaadka qaba HIV laga bilaabo da'da 35 ilaa dhimasho.
Inkasta oo kharashka daaweynta loogu talagalay dadka bilaabay daaweynta cudurka ($ 435,200) ay aad uga sarreeyeen kuwa dib u dhigista daaweynta ($ 326,500), ka badbaadinta cudurada iyo ka hortagga isbitaaleynta waxaa loo tixgeliyey mid la taaban karo.
Baadhayaashu waxay kaloo awoodaan inay ku soo gabagabeeyaan in kaydka kharashka nolosha ah ee looga hortago infekshanka HIV ee qof keliya uu ahaa $ 229,800 illaa $ 338,400.
Qabashada Kharashka Nolol-badbaadinta ee HIV-ga
Inkasta oo qiimaha nololeed ee nolosha daaweyntu ku dhici karto, dusha sare, waxay u muuqataa qiimaha daaweynta HIV-ga ee khatarta ah ama kharashka daryeelka caafimaadka Maraykanka-waa muhiim in la eego kharashka ku xiran walaacyada kale ee caafimaadka.
Tixgeli, tusaale ahaan, in celceliska nolosha sigaarka lagu cabbo 24-sano jirka ah waa $ 183,000, halka haweeney 24-jir ah ay filan karto in ay ku bixiso celcelis ahaan $ 86,000. Marka laga reebo kharashka sigaarka, kharashka bulshada ee Medicare, Medicaid, Social Security, iyo caymiska caafimaadka ayaa loo arkaa inay u muuqdaan kuwo aad u weyn - haddii ay sabab u tahay joojinta sigaar-cabista , amphysema, kansarka sanbabada, iwm.
(Tirooyinkan ayaa sii xumeeyey iyada oo xaqiiqda ah in sigaar cabidda, sida madax-bannaan, ayaa la ogyahay in la yareeyo mudada noolaanshaha ilaa 12.3 sano ee dadka qaba HIV.)
Dhanka kale, qiimaha nololeed ee cabitaanka khamriga saddexda cabitaan ee maalintii waxay keenaysaa $ 263,000 oo ah $ 263,000 noloshiisa, taas oo xiriir la leh 41% halis dheeraad ah ee kansarka ragga, haddii HIV-ga ama HIV-negative.
Istaraatiijiyooyinka Kharashka Miisaaniyadda
Midkoodna maahan, dabcan, waxaa loola jeedaa inuu yareeyo saameeynta dhaqaale ee HIV, labadaba shakhsiga iyo nidaamka daryeelka caafimaad guud ahaan.
Marka laga eego aragtida shakhsiga ah, kharashka daryeelka HIV wuxuu si toos ah ula xiriiraa sida bukaanka loo xannaaneeyo daryeelka iyo sida wanaagsan ee qofkaas u adeeci karo daaweynta loo qoray. Bishii Maajo 2014 ee dib-u-habeynta daaweynta HIV ee Maraykanka, Waaxda Caafimaadka iyo Adeegyada Dadweynaha (DHHS) ayaa wax ka qabatay cabashooyinkan iyada oo kugula talinaysa in bukaan-yahanno-yahannada "ay yareeyaan bukaanka" kharashka ka baxsan daroogada la xariira mar kasta oo ay macquul tahay. "
Tan waxaa ka mid ah isticmaalka daroogooyinka jeneralka ah marka ay macquul tahay ama macquul yihiin. Si kastaba ha noqotee, go'aanka waa inuu la socdaa qiimeyn taxaddar ah oo ku saabsan haddii qiimaha hoos u dhaca uu kordho culeyska kiniinka ee bukaanka.
Xaaladahan oo kale, isticmaalka jeneraalku wuxuu yareyn karaa kharashyada guud, laakiin kharashka ku xirnaanta bukaanka . Waxaa intaa dheer, qaybaha guud ee daaweyn badan oo daroogo ah waxay u horseedi karaan is-dhaafsiga caymiska sare, sii kordhaya halkii laga yareeyn lahaa kharashyada ka baxsan jeebka.
Dhiig la mid ah, DHHS waxay ku talisay hoos u dhaca joogtada ah ee kororka daaweynta CD4 ee loogu talagalay bukaannada ku jiray ART ugu yaraan labo sano waxayna qaadeen culeys fara badan oo aan la ogaan karin. Inkastoo tani ay u muuqato in ay saameyn ku yeelanayso marka la eego xaddiga kharashka dhabta ah, imtixaanada la xidhiidha sida CD8 iyo CD19, dhab ahaantii, qaali ah; ma laha qiimeeyn caafimaad oo keli ah; laguma talinayo sida koorsada daryeelka caafimaad ee la-maamulay ee HIV.
Kuwa loogu soo bandhigay cadaadiska mudada dheer ee fayraska ART, DHHS waxay hadda ku talineysaa
- Kormeerka CD4 waxaa la sameeyaa 12-kii biloodba mar oo loogu talagalay kuwa leh CD4 waxay tiriyaan inta u dhaxaysa 300 iyo 500 unug / mL, iyo;
- Kormeerka CD4 waxaa loo tixgeliyaa ikhtiyaarka loogu talagalay dadka leh CD4 waxay tirinayaan in ka badan 500 unug / mL.
Sida ku cad jadwalka, CD4 wuxuu si toos ah u tiriyaa marka la bilaabayo ama joojiyo daaweynta qallafsan ee loogu talagalay in looga hortago infakshanka fursadaha , ama in la qiimeeyo in jawaabta maskaxda ee ART ay tahay mid ku filan. (Jawaab "ku filan" ayaa lagu qeexay sida korodhka tirada CD4 illaa 50 illaa 150 unugyada inta lagu jiro sanadka ugu horeeya ee daaweynta, oo la mid ah kordhinta isku midka ah sannad kasta illaa heer degmo oo deg deg ah.)
Taas bedelkeeda, baaritaanka culeyska fayruska waa in loo tixgeliyaa barometerka muhiimka ah ee lagu guuleysto daaweynta. Sidan oo kale, DHHS waxay ku talinaysaa kormeerka xajinta fayruska 3-4 bilood kasta oo loogu talagalay bukaanada leh ciribtirka cirridka oo joogto ah, xasilloon.
Ilaha:
Farnham, P .; Gopalappa, C .; Sansom, S .; et al. "Cusboonaysiinta Khidmadaha Lifetime ee Daryeelka iyo Saadaalinta Tayada Nolosha ee Dadka qaba HIV-ga ee Maraykanka: Calaamadaha Hore ee Calaamadaha iyo Gelitaanka Daryeelka." Wargeyska Nidaamka Immune Deficiency Immunities. Oktoobar 2013: 64: 183-189.
Schackman, B .; Fleishman, J .; Su, A ..; et al. "Badbaadinta kharashka caafimaad ee nolosha oo dhan laga hortago HIV-ga Mareykanka." 2015 Shirka Retroviruses iyo Caabuqyada Fursadaha (CROI). Febraayo 23-26, 2015; Seattle, Washington, abstract 1104.
Wasaaradda Caafimaadka ee Mareykanka iyo Adeegyada Aadanaha (DHHS). "Tilmaamaha Isticmaalka Aaladaha Antiretroviral ee dadka qaba HIV-1-Infekshan Dadka waaweyn iyo Dhalinyarada." Bethesda, Maryland; heley May 6, 2016.