Cost and outcomes of paediatric antiretroviral treatment in South Africa
Cost and outcomes of paediatric antiretroviral treatment in South Africa
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DOI：
10.1097/qad.0b013e32835a5b92
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发表时间：
2013-01-14
期刊：
影响因子：
3.8
通讯作者：
Rosen, Sydney
中科院分区：
文献类型：
--
作者：
Meyer-Rath, Gesine;Brennan, Alana;Rosen, Sydney
目的：人们对低收入和中等收入国家儿童抗逆转录病毒治疗（ART）的费用知之甚少。我们分析了南非在开始 ART 后的头 2 年中提供儿科 ART 的平均成本，并按患者结果分层。方法：我们收集了 2005 年至 2009 年约翰内斯堡两家公共诊所 Empilweni 服务和研究中心 (ESRU) 和 Harriet Shezi 儿童诊所 (HSCC) 288 名儿童的门诊资源使用和治疗结果的数据。患者层面的资源使用情况是根据患者记录估计的。单位成本数据来自网站账户和公共部门来源。开始后第 12 个月和第 24 个月的患者结果是根据患者体重 CD4 细胞计数/百分比、病毒载量以及新的 WHO 3/4 期病症的存在来定义的。结果：开始时的中位年龄/CD4 百分比在 ESRU 中分别为 4.03 岁/12.40%，在 HSCC 中分别为 5.84 岁/14.05%。 ESRU 和 HSCC 中，第 12 个月时，分别有 62% 和 91% 的患者仍在接受护理并对治疗做出反应，第 24 个月时，这一比例分别为 68% 和 80%。ESRU 中每位患者接受护理和缓解的平均成本为第 1 年 830 美元和第 2 年 717 美元，HSCC 中为 678 美元和 782 美元。抗逆转录病毒药物占总费用的 33-52%，门诊占 23-31%，实验室检查 12-16%，固定费用 8-18%。结论：两家诊所的费用各不相同，但与成人 ART 的费用相当。在这两个诊所中，很少有幼儿接受抗逆转录病毒治疗，而接受抗逆转录病毒疗法的儿童已经病得很重，这强调了早期婴儿治疗的重要性。 (c) 2013 年 Wolters Kluwer Health 竖条 Lippincott Williams & Wilkins 艾滋病 2013 年，27:243-250
Objective: Little is known about the cost of paediatric antiretroviral treatment (ART) in low-income and middle-income countries. We analysed the average cost of providing paediatric ART in South Africa during the first 2 years after ART initiation, stratified by patient outcomes.Methods: We collected data on outpatient resource use and treatment outcomes of 288 children in two Johannesburg public clinics, Empilweni Services and Research Unit (ESRU) and Harriet Shezi Children's Clinic (HSCC) from 2005 to 2009. Patient-level resource use was estimated from patient records. Unit cost data came from site accounts and public-sector sources. Patient outcomes at month 12 and 24 after initiation were defined based on patients' weight CD4 cell counts/percentages, viral loads, and the presence of new WHO stage 3/4 conditions.Results: Median age/CD4 percentage at initiation was 4.03 years/12.40% in ESRU and 5.84 years/14.05% in HSCC, respectively. Sixty-two and 91% of patients remained in care and responding to treatment at month 12 in ESRU and HSCC, respectively, and 68 and 80% at month 24. The average cost per patient in care and responding was US$ 830 in year 1 and US$ 717 in year 2 in ESRU and US$ 678 and US$ 782 in HSCC. Antiretroviral drugs comprised 33-52% of total cost, clinic visits 23-31%, lab tests 12-16%, and fixed costs 8-18%.Conclusions: Costs varied between the two clinics but were comparable with those of adult ART. Few very young children accessed ART in either clinic and those who did were already very ill, emphasizing the importance of early infant treatment. (c) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins AIDS 2013, 27:243-250