Estimated Costs for Delivery of HIV Antiretroviral Therapy to Individuals with CD4+ T-Cell Counts &gt;350 cells/uL in Rural Uganda

Jain, Vivek; Chang, Wei; Byonanebye, Dathan Mirembe; Owaraganise, Asiphas; Twinomuhwezi, Ellon; Amanyire, Gideon; Black, Douglas; Marseille, Elliot; Kamya, Moses R.; Havlir, Diane V.; Kahn, James G.

doi:10.1371/journal.pone.0143433

Cited by 20 publications

(20 citation statements)

References 37 publications

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“…The costs for EC interventions are found to be considerably lower than other health programmes in the Ugandan setting such as tuberculosis treatment ($151), HIV antiretroviral therapy ($628) and obstetric stula repair ($378). [32][33][34] Emergency care could be highly impactful in Uganda,…”

Section: Discussionmentioning

confidence: 99%

The Costs of Delivering Emergency Care at Regional Referral Hospitals in Uganda: A Micro-Costing Study

Werner

Lin

Risko

et al. 2020

Preprint

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BACKGROUNDUganda experiences a high morbidity and mortality burden due to conditions amenable to emergency care, yet few public hospitals have dedicated emergency units. As a result, little is known about the costs and effects of delivering lifesaving emergency care, hindering health systems planning, budgeting and prioritization exercises. To determine healthcare costs of emergency care services at public facilities in Uganda, we estimate the median cost of care for five sentinel conditions and 13 interventions.METHODSA direct, activity-based costing was carried out at five regional referral hospitals over a four-week period from September to October 2019. Hospital costs were determined using bottom up micro-costing methodology from a provider perspective. Resource use was enumerated via observation and unit costs were derived from National Medical Stores lists. Cost per condition per patient and measures of central tendency for conditions and interventions were calculated. Kruskal-Wallis H-tests and Nemyeni post-hoc tests were conducted to determine significant differences between costs of the conditions.RESULTS872 patient cases were captured with an overall median cost of care of $15.17 USD ($14.08 to $18.85). The median cost per condition was highest for post-partum haemorrhage at $16.87 ($14.66 to $20.99), followed by road traffic injuries at $15.59 ($14.15 to $19.93), asthma at $15.53 ($14.39 to $18.87), pneumonia at $15.18 ($14.28 to $19.72), and paediatric diarrhoea at $14.25 ($13.38 to $15.20). The median cost per intervention was highest for fracture reduction and splinting at $27.41 ($21.63 to $31.14). Cost values differ between sentinel conditions (p <0.05) with treatments for paediatric diarrhoea having the lowest median cost of all conditions (p<0.05).CONCLUSIONThis study is the first to describe the direct costs of EC in hospitals in Uganda by observing the delivery of clinical services, using robust activity-based costing and time motion methodology. We find that emergency care interventions for key drivers of morbidity and mortality can be delivered at considerably lower costs than many priority health interventions. Further research assessing acute care delivery would be useful in planning wider health care delivery systems development.

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Section: Discussionmentioning

confidence: 99%

The Costs of Delivering Emergency Care at Regional Referral Hospitals in Uganda: A Micro-Costing Study

Werner

Lin

Risko

et al. 2020

Preprint

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“…In comparison, the mean annual price for first line ART is $100 per year in sub-Saharan Africa, and delivery of ART including lab monitoring and personnel costs is estimated between $150 and $500 US dollars per person-year, suggesting that CRAG screening is relatively inexpensive and could serve as a key peri-ART intervention for immunosuppressed patients [49, 50]. …”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of CRAG-LFA screening for cryptococcal meningitis among people living with HIV in Uganda

et al. 2017

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BackgroundCryptococcal meningitis (CM) constitutes a significant source of mortality in resource-limited regions. Cryptococcal antigen (CRAG) can be detected in the blood before onset of meningitis. We sought to determine the cost-effectiveness of implementing CRAG screening using the recently developed CRAG lateral flow assay in Uganda compared to current practice without screening.MethodsA decision-analytic model was constructed to compare two strategies for cryptococcal prevention among people living with HIV with CD4 < 100 in Uganda: No cryptococcal screening vs. CRAG screening with WHO-recommended preemptive treatment for CRAG-positive patients. The model was constructed to reflect primary HIV clinics in Uganda, with a cohort of HIV-infected patients with CD4 < 100 cells/uL. Primary outcomes were expected costs, DALYs, and incremental cost-effectiveness ratios (ICERs). We evaluated varying levels of programmatic implementation in secondary analysis.ResultsCRAG screening was considered highly cost-effective and was associated with an ICER of $6.14 per DALY averted compared to no screening (95% uncertainty range: $-20.32 to $36.47). Overall, implementation of CRAG screening was projected to cost $1.52 more per person, and was projected to result in a 40% relative reduction in cryptococcal-associated mortality. In probabilistic sensitivity analysis, CRAG screening was cost-effective in 100% of scenarios and cost saving (ie cheaper and more effective than no screening) in 30% of scenarios. Secondary analysis projected a total cost of $651,454 for 100% implementation of screening nationally, while averting 1228 deaths compared to no screening.ConclusionCRAG screening for PLWH with low CD4 represents excellent value for money with the potential to prevent cryptococcal morbidity and mortality in Uganda.

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“…We applied a micro‐costing method of measuring resources and associated prices, using monthly budget reports, meeting reports, clinical protocols, and work contract information to quantify resources . We conducted informal semistructured interviews and focus groups to estimate time spent on clinical activities, and conducted a time and motion study during the Continuing Operations period . We calculated the proportion of time spent with discrete clinical‐related activities for each staff type including time on the phone or e‐mail with dyads, preparing and reviewing cases, documenting the encounters, and consulting other providers or supervising/being supervised.…”

Section: Methodsmentioning

confidence: 99%

“…15,16 We conducted informal semistructured interviews and focus groups to estimate time spent on clinical activities, and conducted a time and motion study during the Continuing Operations period. 17 We calculated the proportion of time spent with discrete clinical-related activities for each staff type including time on the phone or e-mail with dyads, preparing and reviewing cases, documenting the encounters, and consulting other providers or supervising/being supervised. For information on the time and motion methodology and clinical time distribution, see Text S2 and Tables S1 and S2.…”

Section: Cost Approachmentioning

confidence: 99%

Variations in Costs of a Collaborative Care Model for Dementia

Rosa

Possin

Bernstein

et al. 2019

J American Geriatrics Society

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OBJECTIVES Care coordination programs can improve patient outcomes and decrease healthcare expenditures; however, implementation costs are poorly understood. We evaluate the direct costs of implementing a collaborative dementia care program. DESIGN We applied a micro‐costing analysis to calculate operational costs per‐participant‐month between March 2015 and May 2017. SETTING The University of California, San Francisco (UCSF) and the University of Nebraska Medical Center (UNMC). PARTICIPANTS Participants diagnosed with dementia, enrolled in Medicare or Medicaid, 45 years of age or older, residents of California, Nebraska or Iowa, and having a caregiver. The sample was 272 (UCSF) and 192 (UNMC) participants. INTERVENTION A collaborative dementia care program provided by care team navigators (CTNs), advanced practice nurses, a social worker, and a pharmacist, focusing on caregiver support and education, medications, advance care planning, and behavior symptom management. MEASUREMENTS We measured costs (personnel, supplies, equipment, and training costs) during three program periods, Start‐up, Early Operations, and Continuing Operations, and estimated the effects of caseload variation on costs. RESULTS Start‐up and Early Operations costs were, respectively, $581 and $328 (California), and $501 and $219 (Nebraska) per‐participant‐month. Average costs decreased across phases to $241 (California) and $142 (Nebraska) per‐participant‐month during Continuing Operations. We estimated that costs would range between $75 (UNMC) and $92 (UCSF) per‐participant‐month with the highest projected caseloads (90). CONCLUSION We found that CTN caseload is an important driver of service cost. We provide strategies for maximizing caseload without sacrificing quality of care. We also discuss current barriers to broad implementation that can inform new reimbursement policies. J Am Geriatr Soc 67:2628–2633, 2019

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Estimated Costs for Delivery of HIV Antiretroviral Therapy to Individuals with CD4+ T-Cell Counts >350 cells/uL in Rural Uganda

Cited by 20 publications

References 37 publications

The Costs of Delivering Emergency Care at Regional Referral Hospitals in Uganda: A Micro-Costing Study

The Costs of Delivering Emergency Care at Regional Referral Hospitals in Uganda: A Micro-Costing Study

Cost-effectiveness of CRAG-LFA screening for cryptococcal meningitis among people living with HIV in Uganda

Variations in Costs of a Collaborative Care Model for Dementia

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