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Cost-effectiveness of anti-retroviral therapy at a district hospital in southern Ethiopia.

Bikilla AD, Jerene D, Robberstad B, Lindtjørn B - Cost Eff Resour Alloc (2009)

Bottom Line: We measured the health effect as life years gained (LYG) for patients receiving ART compared with those not receiving such treatment.We used Markov model to estimate the lifetime costs, health benefits and cost-effectiveness of ART.ART yielded an undiscounted 9.4 years expected survival, and resulted in 7.1 extra LYG compared to patients not receiving ART.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for International Health, University of Bergen, Post box 7804, 5020 Bergen, Norway. asfawd@gmail.com

ABSTRACT

Background: As the resource implications of expanding anti-retroviral therapy (ART) are likely to be large, there is a need to explore its cost-effectiveness. So far, there is no such information available from Ethiopia.

Objective: To assess the cost-effectiveness of ART for routine clinical practice in a district hospital setting in Ethiopia.

Methods: We estimated the unit cost of HIV-related care from the 2004/5 fiscal year expenditure of Arba Minch Hospital in southern Ethiopia. We estimated outpatient and inpatient service use from HIV-infected patients who received care and treatment at the hospital between January 2003 and March 2006. We measured the health effect as life years gained (LYG) for patients receiving ART compared with those not receiving such treatment. The study adopted a health care provider perspective and included both direct and overhead costs. We used Markov model to estimate the lifetime costs, health benefits and cost-effectiveness of ART.

Findings: ART yielded an undiscounted 9.4 years expected survival, and resulted in 7.1 extra LYG compared to patients not receiving ART. The lifetime incremental cost is US$2,215 and the undiscounted incremental cost per LYG is US$314. When discounted at 3%, the additional LYG decreases to 5.5 years and the incremental cost per LYG increases to US$325.

Conclusion: The undiscounted and discounted incremental costs per LYG from introducing ART were less than the per capita GDP threshold at the base year. Thus, ART could be regarded as cost-effective in a district hospital setting in Ethiopia.

No MeSH data available.


Related in: MedlinePlus

The Markov states and pattern of HIV disease progression.
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Figure 1: The Markov states and pattern of HIV disease progression.

Mentions: Markov modelling is suitable for analysing different outcomes when the clinical course of the disease has an extended time horizon, and when the nature of the condition is such that patients experience different health states at different points in time. The technique allows estimating life expectancies and lifetime costs [14-16]. We based our model on the WHO HIV clinical staging system [12], grouping the four clinical stages into two health states: non-AIDS HIV state (i.e. WHO clinical stages I, II & III); and AIDS state (i.e. WHO stage IV). The two alive clinical states of the HIV disease (i.e. no-AIDS and AIDS states) and the 'dead' state (i.e. death from AIDS) form the three states in the Markov model of our study (Figure 1).


Cost-effectiveness of anti-retroviral therapy at a district hospital in southern Ethiopia.

Bikilla AD, Jerene D, Robberstad B, Lindtjørn B - Cost Eff Resour Alloc (2009)

The Markov states and pattern of HIV disease progression.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2724492&req=5

Figure 1: The Markov states and pattern of HIV disease progression.
Mentions: Markov modelling is suitable for analysing different outcomes when the clinical course of the disease has an extended time horizon, and when the nature of the condition is such that patients experience different health states at different points in time. The technique allows estimating life expectancies and lifetime costs [14-16]. We based our model on the WHO HIV clinical staging system [12], grouping the four clinical stages into two health states: non-AIDS HIV state (i.e. WHO clinical stages I, II & III); and AIDS state (i.e. WHO stage IV). The two alive clinical states of the HIV disease (i.e. no-AIDS and AIDS states) and the 'dead' state (i.e. death from AIDS) form the three states in the Markov model of our study (Figure 1).

Bottom Line: We measured the health effect as life years gained (LYG) for patients receiving ART compared with those not receiving such treatment.We used Markov model to estimate the lifetime costs, health benefits and cost-effectiveness of ART.ART yielded an undiscounted 9.4 years expected survival, and resulted in 7.1 extra LYG compared to patients not receiving ART.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for International Health, University of Bergen, Post box 7804, 5020 Bergen, Norway. asfawd@gmail.com

ABSTRACT

Background: As the resource implications of expanding anti-retroviral therapy (ART) are likely to be large, there is a need to explore its cost-effectiveness. So far, there is no such information available from Ethiopia.

Objective: To assess the cost-effectiveness of ART for routine clinical practice in a district hospital setting in Ethiopia.

Methods: We estimated the unit cost of HIV-related care from the 2004/5 fiscal year expenditure of Arba Minch Hospital in southern Ethiopia. We estimated outpatient and inpatient service use from HIV-infected patients who received care and treatment at the hospital between January 2003 and March 2006. We measured the health effect as life years gained (LYG) for patients receiving ART compared with those not receiving such treatment. The study adopted a health care provider perspective and included both direct and overhead costs. We used Markov model to estimate the lifetime costs, health benefits and cost-effectiveness of ART.

Findings: ART yielded an undiscounted 9.4 years expected survival, and resulted in 7.1 extra LYG compared to patients not receiving ART. The lifetime incremental cost is US$2,215 and the undiscounted incremental cost per LYG is US$314. When discounted at 3%, the additional LYG decreases to 5.5 years and the incremental cost per LYG increases to US$325.

Conclusion: The undiscounted and discounted incremental costs per LYG from introducing ART were less than the per capita GDP threshold at the base year. Thus, ART could be regarded as cost-effective in a district hospital setting in Ethiopia.

No MeSH data available.


Related in: MedlinePlus