Sydney Rosen1, Lawrence Long, Ian Sanne. 1. Center for International Health and Development, Boston University, Boston, MA 02118, USA. sbrosen@bu.edu
Abstract
OBJECTIVE: Estimate the average outpatient cost per patient in care and responding to treatment 1 year after initiation of antiretroviral therapy (ART) under different models of treatment delivery in South Africa. METHODS: At each site, medical records for a sample patients of were reviewed 1 year after ART initiation. Each subject was assigned to one outcome category: in care and responding (IC); in care but not responding (NR); or no longer in care at study site (NIC). Average cost per outcomes category was estimated based on resource utilisation. RESULTS: Site 1 was an urban public hospital; Site 2 a programme that contracts private general practitioners; Site 3 a rural non-governmental (NGO) AIDS clinic; and Site 4 a peri-urban NGO primary care clinic. At month 12, IC, NR and NIC rates were 67%, 7% and 26% (Site 1); 52%, 3%, and 45% (Site 2); 63%, 9% and 28% (Site 3); and 76%, 11%, and 13% (Site 4). The average outpatient cost per patient initiated was $756 (Site 1), $896 (Site 2), $932 (Site 3) and $1,126 (Site 4). When all costs and all outcomes were taken into account, the average cost to produce an IC patient was $1,128 (Site 1), $1,723 (Site 2), $1,480 (Site 3), and $1,482 (Site 4). CONCLUSION: If all ART patients remain in care and responding, total costs will increase but the average cost to produce an IC patient will fall. The cost per ART patient treated varies moderately among sites. Cost differences increase markedly when patient outcomes are taken into account.
OBJECTIVE: Estimate the average outpatient cost per patient in care and responding to treatment 1 year after initiation of antiretroviral therapy (ART) under different models of treatment delivery in South Africa. METHODS: At each site, medical records for a sample patients of were reviewed 1 year after ART initiation. Each subject was assigned to one outcome category: in care and responding (IC); in care but not responding (NR); or no longer in care at study site (NIC). Average cost per outcomes category was estimated based on resource utilisation. RESULTS: Site 1 was an urban public hospital; Site 2 a programme that contracts private general practitioners; Site 3 a rural non-governmental (NGO) AIDS clinic; and Site 4 a peri-urban NGO primary care clinic. At month 12, IC, NR and NIC rates were 67%, 7% and 26% (Site 1); 52%, 3%, and 45% (Site 2); 63%, 9% and 28% (Site 3); and 76%, 11%, and 13% (Site 4). The average outpatient cost per patient initiated was $756 (Site 1), $896 (Site 2), $932 (Site 3) and $1,126 (Site 4). When all costs and all outcomes were taken into account, the average cost to produce an IC patient was $1,128 (Site 1), $1,723 (Site 2), $1,480 (Site 3), and $1,482 (Site 4). CONCLUSION: If all ART patients remain in care and responding, total costs will increase but the average cost to produce an IC patient will fall. The cost per ART patient treated varies moderately among sites. Cost differences increase markedly when patient outcomes are taken into account.
Authors: Matthew P Fox; Mhairi Maskew; A Patrick MacPhail; Lawrence Long; Alana T Brennan; Daniel Westreich; William B MacLeod; Pappie Majuba; Ian M Sanne Journal: Int J Epidemiol Date: 2012-03-20 Impact factor: 7.196
Authors: Mariana Siapka; Michelle Remme; Carol Dayo Obure; Claudia B Maier; Karl L Dehne; Anna Vassall Journal: Bull World Health Organ Date: 2014-04-01 Impact factor: 9.408
Authors: Catherine G Sutcliffe; Carolyn Bolton-Moore; Janneke H van Dijk; Matt Cotham; Bushimbwa Tambatamba; William J Moss Journal: BMC Pediatr Date: 2010-07-30 Impact factor: 2.125
Authors: Rory Leisegang; Susan Cleary; Michael Hislop; Alistair Davidse; Leon Regensberg; Francesca Little; Gary Maartens Journal: PLoS Med Date: 2009-12-01 Impact factor: 11.069