The outcomes and outpatient costs of different models of antiretroviral treatment delivery in South Africa
The outcomes and outpatient costs of different models of antiretroviral treatment delivery in South Africa
复制标题
DOI：
10.1111/j.1365-3156.2008.02114.x
复制
发表时间：
2008-08-01
影响因子：
3.3
通讯作者：
Sanne, Ian
中科院分区：
文献类型：
--
作者：
Rosen, Sydney;Long, Lawrence;Sanne, Ian
目的估算南非不同治疗模式下抗逆转录病毒治疗(ART)开始后1年的人均门诊费用。方法在每个地点，在ART开始1年后对样本患者的医疗记录进行回顾。每个受试者被分配到一个结果类别：在护理和反应(IC)；在护理但没有反应(NR)；或不再在研究地点护理(NIC)。结果站点1是一家城市公立医院；站点2是与私人全科医生签约的方案；站点3是农村非政府(NGO)艾滋病诊所；以及站点4是城市周边的非政府组织初级保健诊所。在12个月时，IC、NR和NIC率分别为67%、7%和26%(站点1)；52%、3%和45%(站点2)；63%、9%和28%(站点3)；76%、11%和13%(站点4)。每名患者的平均门诊费用分别为756美元(站点1)、896美元(站点2)、932美元(站点3)和1,126美元(站点4)。当考虑到所有成本和所有结果时，生产一名IC患者的平均成本为1,128美元(站点1)、1,723美元(站点2)、1,480美元(站点3)和1,482美元(站点4)。结论如果所有ART患者继续接受治疗和应答，总成本将增加，但生产IC患者的平均成本将下降。每个抗逆转录病毒治疗患者的治疗费用在不同的地点略有不同。当考虑到患者的结果时，成本差异显著增加。
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.