Economic evaluation of differentiated service delivery models for HIV treatment in Lesotho: costs to providers and patients.
Economic evaluation of differentiated service delivery models for HIV treatment in Lesotho: costs to providers and patients.
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DOI：
10.1002/jia2.25692
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发表时间：
2021-04
影响因子：
6
通讯作者：
Fatti G
中科院分区：
文献类型：
--
作者：
Nichols BE;Cele R;Lekodeba N;Tukei B;Ngorima-Mabhena N;Tiam A;Maotoe T;Sejana MV;Faturiyele IO;Chasela C;Rosen S;Fatti G
莱索托是世界上艾滋病毒/艾滋病发病率第二高的国家（23.6%），在实现联合国艾滋病规划署的“95 - 95 - 95”目标方面取得了相当大的进展，但最近在改善所有已知艾滋病毒阳性者的治疗机会方面取得的成功严重制约了现有的医疗基础设施，财政和人力资源。莱索托还面临着一个挑战，即农村人口占大多数，他们去医疗机构看病要花费大量的时间和财力。使用2017年8月至2019年7月期间进行的一项群集随机非劣效性试验的数据，我们评估了莱索托基于社区的抗逆转录病毒治疗（ART）多月交付差异化模式的提供者成本和患者成本。多个月分发试验比较了三个组12个月的护理保留：常规护理，需要每季度进行一次设施访问和ART分发（3 MF）;三个月的社区依从性组（CAG）（3 MC）和六个月的社区ART分发（6 MCD）。我们首先估计了提供HIV护理和治疗的平均年总成本，然后是每个组入组后12个月保留的每位患者的总成本，使用试验的资源利用数据和当地单位成本。然后，我们用自我报告的问卷数据估计了每组患者的平均年成本。为每位患者提供艾滋病毒护理和治疗的平均年总成本在3 MF组中最高（122.28美元，标准差[SD] 23.91美元），其次是3 MC（114.20美元，SD 23.03美元）和6 MCD组（112.58美元，SD 21.44美元）。每例患者保留护理，3 MF组的平均提供者成本为125.99美元（SD 24.64美元），其他两组的平均提供者成本低6%至8%（3 MC和6 MCD分别为118.38美元，SD 23.87美元和118.83美元，SD 22.63美元）。两个差异化服务提供组的患者成本大幅降低：从3 MF组的每年44.42美元（SD $12.06）降至3 MC组的每年16.34美元（SD $5.11）（降低63%）和6 MCD组的每年18.77美元（SD $8.31）（降低58%）。莱索托以社区为基础的多月抗逆转录病毒疗法模式可能为治疗提供者节省少量费用，为莱索托患者节省大量费用。患者成本节约可以支持长期坚持和保留护理。
Lesotho, the country with the second‐highest HIV/AIDS prevalence (23.6%) in the world, has made considerable progress towards achieving the “95‐95‐95” UNAIDS targets, but recent success in improving treatment access to all known HIV positive individuals has severely strained existing healthcare infrastructure, financial and human resources. Lesotho also faces the challenge of a largely rural population who incur a significant time and financial burden to visit healthcare facilities. Using data from a cluster‐randomized non‐inferiority trial conducted between August 2017 and July 2019, we evaluated costs to providers and costs to patients of community‐based differentiated models of multi‐month delivery of antiretroviral therapy (ART) in Lesotho. The trial of multi‐month dispensing compared 12‐month retention in care among three arms: conventional care, which required quarterly facility visits and ART dispensation (3MF); three‐month community adherence groups (CAGs) (3MC) and six‐month community ART distribution (6MCD). We first estimated the average total annual cost of providing HIV care and treatment followed by the total cost per patient retained 12 months after entry for each arm, using resource utilization data from the trial and local unit costs. We then estimated the average annual cost to patients in each arm with self‐reported questionnaire data. The average total annual cost of providing HIV care and treatment per patient was the highest in the 3MF arm ($122.28, standard deviation [SD] $23.91), followed by 3MC ($114.20, SD $23.03) and the 6MCD arm ($112.58, SD $21.44). Per patient retained in care, the average provider cost was $125.99 (SD $24.64) in the 3MF arm and 6% to 8% less for the other two arms ($118.38, SD $23.87 and $118.83, SD $22.63 for the 3MC and 6MCD respectively). There was a large reduction in patient costs for both differentiated service delivery arms: from $44.42 (SD $12.06) annually in the 3MF arm to $16.34 (SD $5.11) annually in the 3MC (63% reduction) and $18.77 (SD $8.31) annually in 6MCD arm (58% reduction). Community‐based, multi‐month models of ART in Lesotho are likely to produce small cost savings to treatment providers and large savings to patients in Lesotho. Patient cost savings may support long‐term adherence and retention in care.
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影响因子：
15.8
作者：
Geldsetzer, Pascal;Francis, Joel M.;Baernighausen, Till
通讯作者：
Baernighausen, Till
影响因子：
4.5
作者：
Faturiyele, I. O.;Appolinare, T.;Pisa, P. T.
通讯作者：
Pisa, P. T.
DOI：
10.1097/qai.0000000000002439
发表时间：
2020-11-01
影响因子：
3.6
作者：
Tukei, Betty B.;Fatti, Geoffrey;Chasela, Charles
通讯作者：
Chasela, Charles
影响因子：
6
作者：
Pinto, Andrew D.;van Lettow, Monique;Sodhi, Sumeet K.
通讯作者：
Sodhi, Sumeet K.
影响因子：
5
作者：
Shepherd, Bryan E.;Blevins, Meridith;Vermund, Sten H.
通讯作者：
Vermund, Sten H.