The costs of providing antiretroviral therapy services to HIV-infected individuals presenting with advanced HIV disease at public health centres in Dar es Salaam, Tanzania: Findings from a randomised trial evaluating different health care strategies
The costs of providing antiretroviral therapy services to HIV-infected individuals presenting with advanced HIV disease at public health centres in Dar es Salaam, Tanzania: Findings from a randomised trial evaluating different health care strategies
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DOI：
10.1371/journal.pone.0171917
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发表时间：
2017-02-24
期刊：
影响因子：
3.7
通讯作者：
Guinness, Lorna
中科院分区：
文献类型：
--
作者：
Kimaro, Godfather Dickson;Mfinanga, Sayoki;Guinness, Lorna
背景了解与卫生保健提供策略相关的成本对于规划至关重要。有几个数据对患者使用的卫生服务资源和他们的相关费用内antiretroviral（ART）programmes in Africa.Material and methodsThe study嵌套在一个大型试验，评估筛查隐球菌脑膜炎和结核病和短期的初始阶段的家庭为基础的坚持支持患者开始ART与先进的艾滋病毒疾病在坦桑尼亚和赞比亚。经济评估仅在坦桑尼亚进行。我们从卫生服务提供者的角度，使用微观成本计算方法估计提供常规ART服务的成本。还估计了提供服务的不同新组成部分的增量成本。所有费用均转换为美元（US$），并根据2012 prices.ResultsOf 870例在坦桑尼亚登记的患者中，434例入组干预组，436例入组标准治疗/对照组。总体而言，入组时的中位（IQR）年龄和CD 4细胞计数分别为38 [31，44]岁和52 [20，89]个细胞/mm 3。在标准治疗组开始ART治疗后的前三个月和一年随访期内，每位患者的平均费用分别为107美元（95%CI 101-112）和265美元（95%CI 254-275）。抗逆转录病毒药物、门诊和住院分别占每患者年总成本的50%、19%和19%，而诊断检测和非抗逆转录病毒药物（复方新诺明）分别占每患者年总成本的10%和2%。在头三个月，干预措施对卫生服务的增加成本为59美元（p
BackgroundUnderstanding the costs associated with health care delivery strategies is essential for planning. There are few data on health service resources used by patients and their associated costs within antiretroviral (ART) programmes in Africa.Material and methodsThe study was nested within a large trial, which evaluated screening for cryptococcal meningitis and tuberculosis and a short initial period of home-based adherence support for patients initiating ART with advanced HIV disease in Tanzania and Zambia. The economic evaluation was done in Tanzania alone. We estimated costs of providing routine ART services from the health service provider's perspective using a micro-costing approach. Incremental costs for the different novel components of service delivery were also estimated. All costs were converted into US dollars (US$) and based on 2012 prices.ResultsOf 870 individuals enrolled in Tanzania, 434 were enrolled in the intervention arm and 436 in the standard care/control arm. Overall, the median (IQR) age and CD4 cell count at enrolment were 38 [31, 44] years and 52 [20, 89] cells/mm3, respectively. The mean per patient costs over the first three months and over a one year period of follow up following ART initiation in the standard care arm were US$ 107 (95%CI 101-112) and US$ 265 (95%CI 254-275) respectively. ART drugs, clinic visits and hospital admission constituted 50%, 19%, and 19% of the total cost per patient year, while diagnostic tests and non-ART drugs (co-tri-moxazole) accounted for 10% and 2% of total per patient year costs. The incremental costs of the intervention to the health service over the first three months was US$ 59 (p