The Silver Tsunami: Projecting multimorbidity, polypharmacy,and healthcare costs for those aging with HIV in the US

银色海啸：预测美国艾滋病毒感染者的多重发病率、多药治疗和医疗保健费用

• 批准号: 9527713
• 负责人: Keri Nicole Althoff
• 金额: $ 50.96万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9527713
• 关键词: AIDS prevention; AIDS/HIV problem; Achievement; Acquired Immunodeficiency Syndrome; Adult; Affect; Age; Age Distribution; Aging; American; Awareness; Baby Booms; Budgets; Cardiovascular system; Caring; Characteristics; Chronic Kidney Failure; Clinical Management; Collaborations; Comorbidity; Cost Savings; Cost of Illness; Data; Disease; Elderly; End stage renal failure; Environment; Epidemiology; Funding; General Population; Geography; Goals; Government; Guidelines; HIV; HIV Infections; Health Care Costs; Health Information System; Health Services; Health Services Accessibility; Health system; Health system plans; Healthcare; Healthcare Systems; Individual; Insulin Resistance; Intervention; Investigation; Knowledge; Life Expectancy; Malignant Neoplasms; Mentored Research Scientist Development Award; Metabolic; Methods; Modeling; Myocardial Infarction; Neurologic; Persons; Pharmaceutical Preparations; Policies; Polypharmacy; Population; Principal Investigator; Privatization; Productivity; Public Health; Race; Research; Research Design; Research Priority; Resource Allocation; Risk; Savings; Seasons; Silver; Subgroup; Tsunami; United States; United States National Institutes of Health; age related; base; co-infection; cohort; cost; cost effectiveness; effective therapy; experience; health care service utilization; human old age (65+); models and simulation; multiple chronic conditions; prevent; programs; public health relevance; sex; transmission process

 DESCRIPTION (provided by applicant): Due to effective treatment, persons living with HIV and accessing care (PLWHC) in the United States (US) now have a life expectancy approaching the general population. In the general population, the population bubble caused by the post-WWII Baby Boom has been referred to as the "Silver Tsunami." The goal of this project is to fill a vital gap for a more detailed, data-based projection of the imminent PLWHC Silver Tsunami to better inform allocation of resources in governmental and private healthcare systems and to identify targets for savings. Taking into account factors that affect the age distribution of PLWHC in the US, we will use simulation models to project the age distribution through 2030 to answer the question: "What does the projected age distribution of PLWHC in the US look like?" To be useful, data need to be disaggregated by important demographic (sex and race) and geographical characteristics. HIV infection has been shown to increase the risk of insulin resistance, chronic kidney disease, myocardial infarction, end-stage renal disease, and cancer. Incorporating multimorbidity and polypharmacy into the projected age distribution will answer: "What is the projected burden of multimorbidity and polypharmacy in adults aging with HIV?" Information derived by a careful, data-based analysis that includes the burden of multimorbidity and polypharmacy in PLWHC will have many uses. We propose to focus on the important issue of healthcare costs as it is likely that costs will be compounded in adults aging with HIV as compared to those without HIV. By investigating the question "How much will it cost to care for adults aging with HIV?" health systems and state and federal budgets can begin to prepare for both HIV-related and non-HIV-related costs and identify targets for potential cost savings. We have assembled a world-class collaboration that combines high-quality longitudinal data, epidemiological expertise, the scientific leaders of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), and the leaders in modeling of HIV disease and healthcare costs from the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) team to achieve the following aims: AIM 1: To fill the gap in knowledge by projecting age-specific proportions of PLWHC in the US through 2030, with estimates tailored to important demographic and geographic sub-groups. AIM 2: To project the burden of multimorbidity and polypharmacy among PLWHC in the US through 2030. AIM 3: To project the annual costs of non-HIV-related healthcare for PLWHC in the US through 2030. The proposed aims align well with the research priorities of the 2016 Trans-NIH Plan for HIV-Related Research and the NIH HIV/AIDS Research Priorities and Guidelines for Determining AIDS Funding. Findings will provide key HIV epidemiologic and health services data that are necessary for guiding research priorities, increasing awareness of multimorbidity and polypharmacy in clinical management, and informing health systems resource allocations.

 描述（由申请人提供）：由于有效的治疗，美国（US）的艾滋病毒感染者和获得护理的人（PLWHC）现在的预期寿命接近普通人群。二战后婴儿潮被称为“白银海啸”。该项目的目标是填补一个重要空白，对即将到来的 PLWHC 白银海啸进行更详细、基于数据的预测，以便更好地为分配提供信息。考虑到影响美国 PLWHC 年龄分布的因素，我们将使用模拟模型来预测到 2030 年的年龄分布，以回答以下问题：“美国 PLWHC 的预计年龄分布是什么样的？”为了发挥作用，数据需要按重要的人口统计（性别和种族）和地理特征进行分类。HIV 感染已被证明会增加胰岛素抵抗、慢性肾病、心肌将多重发病率和多重用药纳入预计年龄分布将回答：“通过仔细的、基于数据的分析得出的信息对于老年艾滋病毒感染者来说多重发病率和多重用药的预计负担是多少？”我们建议重点关注医疗保健费用这一重要问题，因为与艾滋病毒感染者相比，老年艾滋病毒感染者的费用可能会更加复杂。通过调查“照顾感染艾滋病毒的成年人需要多少钱？”这一问题，卫生系统以及州和联邦预算可以开始为与艾滋病毒相关和非艾滋病毒相关的费用做好准备，并确定潜在的目标。我们组建了世界级的合作团队，将高质量的纵向数据、流行病学专业知识、北美艾滋病队列研究与设计合作组织 (NA-ACCORD) 的科学领导者以及艾滋病毒疾病建模领域的领导者结合在一起。和医疗费用预防艾滋病并发症的成本效益 (CEPAC) 团队旨在实现以下目标： 目标 1：通过预测到 2030 年美国 PLWHC 中特定年龄的比例，并对重要的人口和地理子群体进行量身定制的估计，来填补知识空白。目标 2：预测到 2030 年美国 PLWHC 的多重疾病和多重用药负担。 目标 3：预测每年的费用。到 2030 年，为美国的 PLWHC 提供非 HIV 相关的医疗保健。拟议的目标与 2016 年跨 NIH HIV 相关研究计划和 NIH HIV/艾滋病研究优先事项和确定艾滋病资助指南的研究重点非常一致。研究结果将提供关键的艾滋病毒流行病学和卫生服务数据，这些数据对于指导研究重点、提高临床管理中的多发病和多药用药的认识以及为卫生系统资源分配提供信息是必要的。