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Cost analysis of centralized viral load testing for antiretroviral therapy monitoring in Nicaragua, a low-HIV prevalence, low-resource setting.

Gerlach J, Sequeira M, Alvarado V, Cerpas C, Balmaseda A, Gonzalez A, de Los Santos T, Levin CE, Amador JJ, Domingo GJ - J Int AIDS Soc (2010)

Bottom Line: The average cost per patient for transportation, food, lodging and lost income ranged from $3.70 to $14.93.Importantly, the efficiency of results reporting has a large impact on the cost per result delivered to the clinician and utility of the result for patient monitoring.Detailed cost analysis can identify opportunities for removing barriers to effective antiretroviral therapy monitoring programmes in limited-resource countries with low HIV prevalence.

View Article: PubMed Central - HTML - PubMed

Affiliation: Programs for Appropriate Technologies in Health (PATH), Seattle, Washington 98121, USA.

ABSTRACT

Background: HIV viral load testing as a component of antiretroviral therapy monitoring is costly. Understanding the full costs and the major sources of inefficiency associated with viral load testing is critical for optimizing the systems and technologies that support the testing process. The objective of our study was to estimate the costs associated with viral load testing performed for antiretroviral therapy monitoring to both patients and the public healthcare system in a low-HIV prevalence, low-resource country.

Methods: A detailed cost analysis was performed to understand the costs involved in each step of performing a viral load test in Nicaragua, from initial specimen collection to communication of the test results to each patient's healthcare provider. Data were compiled and cross referenced from multiple information sources: laboratory records, regional surveillance centre records, and scheduled interviews with the key healthcare providers responsible for HIV patient care in five regions of the country.

Results: The total average cost of performing a viral load test in Nicaragua varied by region, ranging from US$99.01 to US$124.58, the majority of which was at the laboratory level: $88.73 to $97.15 per specimen, depending on batch size. The average cost to clinics at which specimens were collected ranged from $3.31 to $20.92, depending on the region. The average cost per patient for transportation, food, lodging and lost income ranged from $3.70 to $14.93.

Conclusions: The quantitative viral load test remains the single most expensive component of the process. For the patient, the distance of his or her residence from the specimen collection site is a large determinant of cost. Importantly, the efficiency of results reporting has a large impact on the cost per result delivered to the clinician and utility of the result for patient monitoring. Detailed cost analysis can identify opportunities for removing barriers to effective antiretroviral therapy monitoring programmes in limited-resource countries with low HIV prevalence.

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Relationship between costs and distance. 3A. The distance from home to the SCS for HIV patients in the Atlantic regions. Empty squares represent the direct transportation costs incurred by patients. Filled squares represent fully burdened food, lodging and opportunity costs to patients. 3B. The distance from the SCS to the central testing facility (in Managua). Empty squares represent specimen transport costs. Filled squares represent the cost per viral load test to the healthcare system.
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Figure 3: Relationship between costs and distance. 3A. The distance from home to the SCS for HIV patients in the Atlantic regions. Empty squares represent the direct transportation costs incurred by patients. Filled squares represent fully burdened food, lodging and opportunity costs to patients. 3B. The distance from the SCS to the central testing facility (in Managua). Empty squares represent specimen transport costs. Filled squares represent the cost per viral load test to the healthcare system.

Mentions: Minimum and maximum costs indicate that proximity to the SCS is the main driver of cost to patients (Table 2), with transportation being the main cost contributor. Larger urban sites with a small minority of patients living in remote areas had lower weighted average patient costs (e.g., Site 1). In contrast, in more rural regions, where a larger proportion of patients live in remote areas, the weighted average patient cost was as high as $14.93. The majority of patients - that is, those who live near the clinic - bear a cost well below the average patient cost, whereas the minority of patients who live in remote areas bear a cost well above the average. Overall, 65% of the patients bear a cost of less than $5 for providing a sample, and 95% bear a cost of less than $10. In the Atlantic regions, the terrain imposes significant access challenges, requiring patients to spend up to three days to complete the process of providing a specimen. The relationship between patient distance from the SCS at one Atlantic coast site and cost to the patient is shown in Figure 3A.


Cost analysis of centralized viral load testing for antiretroviral therapy monitoring in Nicaragua, a low-HIV prevalence, low-resource setting.

Gerlach J, Sequeira M, Alvarado V, Cerpas C, Balmaseda A, Gonzalez A, de Los Santos T, Levin CE, Amador JJ, Domingo GJ - J Int AIDS Soc (2010)

Relationship between costs and distance. 3A. The distance from home to the SCS for HIV patients in the Atlantic regions. Empty squares represent the direct transportation costs incurred by patients. Filled squares represent fully burdened food, lodging and opportunity costs to patients. 3B. The distance from the SCS to the central testing facility (in Managua). Empty squares represent specimen transport costs. Filled squares represent the cost per viral load test to the healthcare system.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992476&req=5

Figure 3: Relationship between costs and distance. 3A. The distance from home to the SCS for HIV patients in the Atlantic regions. Empty squares represent the direct transportation costs incurred by patients. Filled squares represent fully burdened food, lodging and opportunity costs to patients. 3B. The distance from the SCS to the central testing facility (in Managua). Empty squares represent specimen transport costs. Filled squares represent the cost per viral load test to the healthcare system.
Mentions: Minimum and maximum costs indicate that proximity to the SCS is the main driver of cost to patients (Table 2), with transportation being the main cost contributor. Larger urban sites with a small minority of patients living in remote areas had lower weighted average patient costs (e.g., Site 1). In contrast, in more rural regions, where a larger proportion of patients live in remote areas, the weighted average patient cost was as high as $14.93. The majority of patients - that is, those who live near the clinic - bear a cost well below the average patient cost, whereas the minority of patients who live in remote areas bear a cost well above the average. Overall, 65% of the patients bear a cost of less than $5 for providing a sample, and 95% bear a cost of less than $10. In the Atlantic regions, the terrain imposes significant access challenges, requiring patients to spend up to three days to complete the process of providing a specimen. The relationship between patient distance from the SCS at one Atlantic coast site and cost to the patient is shown in Figure 3A.

Bottom Line: The average cost per patient for transportation, food, lodging and lost income ranged from $3.70 to $14.93.Importantly, the efficiency of results reporting has a large impact on the cost per result delivered to the clinician and utility of the result for patient monitoring.Detailed cost analysis can identify opportunities for removing barriers to effective antiretroviral therapy monitoring programmes in limited-resource countries with low HIV prevalence.

View Article: PubMed Central - HTML - PubMed

Affiliation: Programs for Appropriate Technologies in Health (PATH), Seattle, Washington 98121, USA.

ABSTRACT

Background: HIV viral load testing as a component of antiretroviral therapy monitoring is costly. Understanding the full costs and the major sources of inefficiency associated with viral load testing is critical for optimizing the systems and technologies that support the testing process. The objective of our study was to estimate the costs associated with viral load testing performed for antiretroviral therapy monitoring to both patients and the public healthcare system in a low-HIV prevalence, low-resource country.

Methods: A detailed cost analysis was performed to understand the costs involved in each step of performing a viral load test in Nicaragua, from initial specimen collection to communication of the test results to each patient's healthcare provider. Data were compiled and cross referenced from multiple information sources: laboratory records, regional surveillance centre records, and scheduled interviews with the key healthcare providers responsible for HIV patient care in five regions of the country.

Results: The total average cost of performing a viral load test in Nicaragua varied by region, ranging from US$99.01 to US$124.58, the majority of which was at the laboratory level: $88.73 to $97.15 per specimen, depending on batch size. The average cost to clinics at which specimens were collected ranged from $3.31 to $20.92, depending on the region. The average cost per patient for transportation, food, lodging and lost income ranged from $3.70 to $14.93.

Conclusions: The quantitative viral load test remains the single most expensive component of the process. For the patient, the distance of his or her residence from the specimen collection site is a large determinant of cost. Importantly, the efficiency of results reporting has a large impact on the cost per result delivered to the clinician and utility of the result for patient monitoring. Detailed cost analysis can identify opportunities for removing barriers to effective antiretroviral therapy monitoring programmes in limited-resource countries with low HIV prevalence.

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