Task-shifting alcohol interventions for HIV plus persons in Kenya: a cost-benefit analysis
Task-shifting alcohol interventions for HIV plus persons in Kenya: a cost-benefit analysis
复制标题
DOI：
10.1186/s12913-017-2169-4
复制
发表时间：
2017-03-28
影响因子：
2.8
通讯作者：
Papas, Rebecca K.
中科院分区：
文献类型：
--
作者：
Galarraga, Omar;Gao, Burke;Papas, Rebecca K.
背景：在 HIV + 患者中，饮酒是 HIV 传播和 HIV 治疗依从性差的一个非常普遍的危险因素。在艾滋病毒普遍流行的低收入国家，大规模实施治疗酗酒问题的有效干预措施仍然是一项挑战。必须考虑干预措施的成本效益（以美元为单位的健康结果）以及长期经济影响或货币形式的“投资回报”。 方法：我们对由辅助专业人员实施的任务转移认知行为疗法 (CBT) 干预进行了成本效益分析，衡量投资的经济回报，以减少肯尼亚 13,440 名门诊患者的饮酒量。在我们的基本案例中，我们从社会角度估计了六年时间范围内的成本和经济效益，年贴现率为 3%。成本包括与培训和实施任务转移 CBT 治疗相关的所有成本。好处包括艾滋病毒发病率降低的经济影响以及家庭和劳动力生产力的提高。我们进行了单变量和多变量概率敏感性分析，以测试结果的稳健性。结果：在基本情况下，CBT 推出的总成本为 554,000 美元，效益价值为 628,000 美元，效益成本比为 1.13。敏感性分析表明，在大多数假设下，效益成本比保持在统一以上，表明干预措施是节省成本的（即具有正的投资回报）。治疗效果的持续时间对敏感性分析的结果影响最大。结论：在肯尼亚，CBT 可以有效且经济地将任务转移给辅助专业人员。干预措施不仅可以降低发病率和死亡率，还可以在中长期内为卫生系统节省经济成本。研究结果对艾滋病毒普遍流行、酒精消费率高以及心理健康专业人员短缺的其他国家具有重要意义。
Background: Among HIV+ patients, alcohol use is a highly prevalent risk factor for both HIV transmission and poor adherence to HIV treatment. The large-scale implementation of effective interventions for treating alcohol problems remains a challenge in low-income countries with generalized HIV epidemics. It is essential to consider an intervention's cost-effectiveness in dollars-per-health-outcome, and the long-term economic impact-or "return on investment" in monetary terms.Methods: We conducted a cost-benefit analysis, measuring economic return on investment, of a task-shifted cognitivebehavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use in a modeled cohort of 13,440 outpatients in Kenya. In our base-case, we estimated the costs and economic benefits from a societal perspective across a six-year time horizon, with a 3% annual discount rate. Costs included all costs associated with training and administering task-shifted CBT therapy. Benefits included the economic impact of lowered HIV incidence as well as the improvements in household and labor-force productivity. We conducted univariate and multivariate probabilistic sensitivity analyses to test the robustness of our results.Results: Under the base case, total costs for CBT rollout was $ 554,000, the value of benefits were $ 628,000, and the benefit-to-cost ratio was 1.13. Sensitivity analyses showed that under most assumptions, the benefit-to-cost ratio remained above unity indicating that the intervention was cost-saving (i. e., had positive return on investment). The duration of the treatment effect most effected the results in sensitivity analyses.Conclusions: CBT can be effectively and economically task-shifted to paraprofessionals in Kenya. The intervention can generate not only reductions in morbidity and mortality, but also economic savings for the health system in the medium and long term. The findings have implications for other countries with generalized HIV epidemics, high prevalence of alcohol consumption, and shortages of mental health professionals.