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Costs of HIV/AIDS treatment in Indonesia by time of treatment and stage of disease.

Siregar AY, Tromp N, Komarudin D, Wisaksana R, van Crevel R, van der Ven A, Baltussen R - BMC Health Serv Res (2015)

Bottom Line: Higher CD4 cell counts at initiation resulted in lower laboratory and opportunistic infection treatment costs.Costs reductions can potentially be realized by early treatment initiation and applying alternative laboratory tests with caution.Scaling up ART at the community level in certain high prevalence settings may improve early uptake, adherence, and reduce transportation costs.

View Article: PubMed Central - PubMed

Affiliation: Integrated Management for Prevention and Control and Treatment of HIV/AIDS (IMPACT), Bandung, Indonesia. adiatma.siregar@fe.unpad.ac.id.

ABSTRACT

Background: We report an economic analysis of Human Immunodeficiency Virus (HIV) care and treatment in Indonesia to assess the options and limitations of costs reduction, improving access, and scaling up services.

Methods: We calculated the cost of providing HIV care and treatment in a main referral hospital in West Java, Indonesia from 2008 to 2010, differentiated by initiation of treatment at different CD4 cell count levels (0-50, 50-100, 100-150, 150-200, and >200 cells/mm(3)); time of treatment; HIV care and opportunistic infections cost components; and the costs of patients for seeking and undergoing care.

Discussion: Before antiretroviral treatment (ART) initiation, costs were dominated by laboratory tests (>65 %), and after initiation, by antiretroviral drugs (≥60 %). Average treatment costs per patient decreased with time on treatment (e.g. from US$580 per patient in the first 6 month to US$473 per patient in months 19-24 for those with CD4 cell counts under 50 cells/mm(3)). Higher CD4 cell counts at initiation resulted in lower laboratory and opportunistic infection treatment costs. Transportation cost dominated the costs of patients for seeking and undergoing care (>40 %).

Conclusions: Costs of providing ART are highest during the early phase of treatment. Costs reductions can potentially be realized by early treatment initiation and applying alternative laboratory tests with caution. Scaling up ART at the community level in certain high prevalence settings may improve early uptake, adherence, and reduce transportation costs.

No MeSH data available.


Related in: MedlinePlus

Average service costs per patient per specified period, health care system perspective (US$). This figure presents the average service costs per patient taking ART. The average costs are separated into specific periods, namely before ART, 1–6 months, 7–12 months, 13–18 months, and 19–24 months within ART. These costs are further separated into CD4 cell count group, namely 0–50, 50–100, 100–150, 150 - 200, and >200 cells/mm3. The figure shows how the average costs per patient in different CD4 cell count groups relatively decrease after the start of ART
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Fig1: Average service costs per patient per specified period, health care system perspective (US$). This figure presents the average service costs per patient taking ART. The average costs are separated into specific periods, namely before ART, 1–6 months, 7–12 months, 13–18 months, and 19–24 months within ART. These costs are further separated into CD4 cell count group, namely 0–50, 50–100, 100–150, 150 - 200, and >200 cells/mm3. The figure shows how the average costs per patient in different CD4 cell count groups relatively decrease after the start of ART

Mentions: Table 3 details the costs associated with providing ART. Before ART initiation, costs were mainly dominated by laboratory tests (including the CD4, viral load, and routine laboratory tests). After the initiation of ART, costs were dominated by ARV, regardless of patients’ CD4 levels. Both total costs and per patient average costs decreased over time after ART initiation. The one anomaly was the OI drugs/treatment cost for patients with a CD4 level of 50 − 100 cells/mm3, which increased from US$725 in 1–6 months to US$2099 in 7–12 months. A relatively high CD4 cell count at treatment initiation relates to relatively low costs of ARVs, laboratory tests, and OI drugs/treatment. Figure 1 shows the average costs per patient for different CD4 cell count levels and over time. The highest average costs for 24 months of ART per patient were for patients with a CD4 cell count <50 cells/mm3. The distribution of cost is provided in the Appendix: Figure 2). The average costs difference between patients undergoing the first 6 months of treatment and the 24 months of treatment is statistically significant within the group of patients with CD4 cell count < 50 cells/mm3, 50 – 100 cells/mm3, and those with >200 cells/mm3. The average 2 year treatment costs difference between the patients with CD4 cell count < 50 cells/mm3 and the groups with higher CD4 cell count is also statistically significant, except with patients with CD4 cell count between 100 – 150 cells/mm3. The statistical significance test is summarized in Appendix: Table 9.Table 3


Costs of HIV/AIDS treatment in Indonesia by time of treatment and stage of disease.

Siregar AY, Tromp N, Komarudin D, Wisaksana R, van Crevel R, van der Ven A, Baltussen R - BMC Health Serv Res (2015)

Average service costs per patient per specified period, health care system perspective (US$). This figure presents the average service costs per patient taking ART. The average costs are separated into specific periods, namely before ART, 1–6 months, 7–12 months, 13–18 months, and 19–24 months within ART. These costs are further separated into CD4 cell count group, namely 0–50, 50–100, 100–150, 150 - 200, and >200 cells/mm3. The figure shows how the average costs per patient in different CD4 cell count groups relatively decrease after the start of ART
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4590258&req=5

Fig1: Average service costs per patient per specified period, health care system perspective (US$). This figure presents the average service costs per patient taking ART. The average costs are separated into specific periods, namely before ART, 1–6 months, 7–12 months, 13–18 months, and 19–24 months within ART. These costs are further separated into CD4 cell count group, namely 0–50, 50–100, 100–150, 150 - 200, and >200 cells/mm3. The figure shows how the average costs per patient in different CD4 cell count groups relatively decrease after the start of ART
Mentions: Table 3 details the costs associated with providing ART. Before ART initiation, costs were mainly dominated by laboratory tests (including the CD4, viral load, and routine laboratory tests). After the initiation of ART, costs were dominated by ARV, regardless of patients’ CD4 levels. Both total costs and per patient average costs decreased over time after ART initiation. The one anomaly was the OI drugs/treatment cost for patients with a CD4 level of 50 − 100 cells/mm3, which increased from US$725 in 1–6 months to US$2099 in 7–12 months. A relatively high CD4 cell count at treatment initiation relates to relatively low costs of ARVs, laboratory tests, and OI drugs/treatment. Figure 1 shows the average costs per patient for different CD4 cell count levels and over time. The highest average costs for 24 months of ART per patient were for patients with a CD4 cell count <50 cells/mm3. The distribution of cost is provided in the Appendix: Figure 2). The average costs difference between patients undergoing the first 6 months of treatment and the 24 months of treatment is statistically significant within the group of patients with CD4 cell count < 50 cells/mm3, 50 – 100 cells/mm3, and those with >200 cells/mm3. The average 2 year treatment costs difference between the patients with CD4 cell count < 50 cells/mm3 and the groups with higher CD4 cell count is also statistically significant, except with patients with CD4 cell count between 100 – 150 cells/mm3. The statistical significance test is summarized in Appendix: Table 9.Table 3

Bottom Line: Higher CD4 cell counts at initiation resulted in lower laboratory and opportunistic infection treatment costs.Costs reductions can potentially be realized by early treatment initiation and applying alternative laboratory tests with caution.Scaling up ART at the community level in certain high prevalence settings may improve early uptake, adherence, and reduce transportation costs.

View Article: PubMed Central - PubMed

Affiliation: Integrated Management for Prevention and Control and Treatment of HIV/AIDS (IMPACT), Bandung, Indonesia. adiatma.siregar@fe.unpad.ac.id.

ABSTRACT

Background: We report an economic analysis of Human Immunodeficiency Virus (HIV) care and treatment in Indonesia to assess the options and limitations of costs reduction, improving access, and scaling up services.

Methods: We calculated the cost of providing HIV care and treatment in a main referral hospital in West Java, Indonesia from 2008 to 2010, differentiated by initiation of treatment at different CD4 cell count levels (0-50, 50-100, 100-150, 150-200, and >200 cells/mm(3)); time of treatment; HIV care and opportunistic infections cost components; and the costs of patients for seeking and undergoing care.

Discussion: Before antiretroviral treatment (ART) initiation, costs were dominated by laboratory tests (>65 %), and after initiation, by antiretroviral drugs (≥60 %). Average treatment costs per patient decreased with time on treatment (e.g. from US$580 per patient in the first 6 month to US$473 per patient in months 19-24 for those with CD4 cell counts under 50 cells/mm(3)). Higher CD4 cell counts at initiation resulted in lower laboratory and opportunistic infection treatment costs. Transportation cost dominated the costs of patients for seeking and undergoing care (>40 %).

Conclusions: Costs of providing ART are highest during the early phase of treatment. Costs reductions can potentially be realized by early treatment initiation and applying alternative laboratory tests with caution. Scaling up ART at the community level in certain high prevalence settings may improve early uptake, adherence, and reduce transportation costs.

No MeSH data available.


Related in: MedlinePlus