Examining catastrophic costs and benefit incidence of subsidized antiretroviral treatment (ART) programme in south-east Nigeria

Onwujekwe, Obinna; Dike, Nkem; Chukwuka, Chinwe; Uzochukwu, Benjamin; Onyedum, Cajetan C; Onoka, Chima; Ichoku, Hyacinth E.

doi:10.1016/j.healthpol.2008.10.006

Cited by 26 publications

(38 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the out-patient departments, where majority of people living with HIV/AIDS (PLWHA) seek treatment, the level of CHE increased as the SES decreased, similar to a previous study in another state[9], with the poorest households suffering the highest catastrophic expenditure for out-patient treatment. The implication of this is that poor households may be driven further into impoverishment[12] as a result of these residual cost burden with an overall negative impact on the achievement of universal health coverage.…”

Section: Discussionsupporting

confidence: 82%

See 1 more Smart Citation

What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?

Etiaba

Onwujekwe

Torpey³

et al. 2016

PLoS ONE

Self Cite

View full text Add to dashboard Cite

BackgroundA gap in knowledge exists regarding the economic burden on households of subsidized anti-retroviral treatment (ART) programs in Nigeria. This is because patients also incur non-ART drug costs, which may constrain the delivery and utilisation of subsidized services.MethodsAn exit survey of adults (18+years) attending health facilities for HIV/AIDS treatment was conducted in three states in Nigeria (Adamawa, Akwa Ibom and Anambra). In the states, ART was fully subsidized but there were different payment modalities for other costs of treatment. Data was collected and analysed for direct and indirect costs of treatment of HIV/AIDS and co-morbidities’ during out-and in-patient visits. The levels of catastrophic health expenditure (CHE) were computed and disaggregated by state, socio-economic status (SES) and urban-rural location of the respondents. Catastrophic Health Expenditure (CHE) in this study measures the number of respondents whose monthly ART-related household expenditure (for in-patient and out-patient visits) as a proportion of monthly non-food expenditure was greater than 40% and 10% respectively.ResultsThe average out-patient and in-patient direct costs were $5.49 and $122.10 respectively. Transportation cost was the highest non-medical cost and it was higher than most medical costs. The presence of co-morbidities contributed to household costs. All the costs were catastrophic to households at 10% and 40% thresholds in the three states, to varying degrees. The poorest SES quintile had the highest incidence of CHE for out-patient costs (p<0.0001). Rural dwellers incurred more CHE for all categories of costs compared to urban dwellers, but the costs were statistically significant for only outpatient costs.ConclusionART subsidization is not enough to eliminate economic burden of treatment on HIV patients. Service decentralization to reduce travel costs, and subsidy on other components of HIV treatment services should be introduced to eliminate the persisting inequitable and high cost burden of ART services. Full inclusion of ART services within the benefit package of the National Health Insurance Scheme should be considered.

show abstract

Section: Discussionsupporting

confidence: 82%

“…A previous study reported the existence of catastrophic expenditure for almost all patients on out-patient visits and for all costs associated with ART. [9]…”

Section: Methodsmentioning

confidence: 99%

What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?

Etiaba

Onwujekwe

Torpey³

et al. 2016

PLoS ONE

Self Cite

View full text Add to dashboard Cite

show abstract

“…Catastrophic expenditure has been reported by some authors among the same study population. 29 and provision of free laboratory services may reduce default at this time.…”

Section: Discussionmentioning

confidence: 99%

Retention and loss to follow-up in antiretroviral treatment programmes in southeast Nigeria

Onoka

Uzochukwu

Onwujekwe

et al. 2012

Pathogens and Global Health

View full text Add to dashboard Cite

Background: This study generated new information about the outcomes of patients enrolled in antiretroviral treatment programmes, as well as the true outcomes of those lost to follow-up (LTF). Methods: Anonymized data were collected for patients enrolled over a 12-month period from two programmes (public and private) in southeast Nigeria. Estimates of retention, LTF, mortality and transfers were computed. All LTF enrollees (defined as patients who had missed three scheduled visits) whose contact information met pre-defined criteria were traced. Results: A total of 481 (public) and 553 (private) records were included. Median duration of follow-up was about 14 months. Cumulative retention and LTF proportions were 66.5 and 32.8% (public), and 82.6 and 11.0% (private) respectively. LTF rates at third, sixth, ninth and twelfth months were 7.5, 19.3, 25.4 and 29.6% respectively (public), and 4.1, 7.1, 9.0 and 10.0% (private). LTF was higher among males, patients with CD4z cell count (200 and public programme enrollees. For the public facility, 56.7% of 104 traceable patients were dead and 38.8% were alive; the figures were 34.2 and 60.5% of 46 patients respectively for the private. Most deaths had occurred by the third month. Conclusion: Not all patients enrolled for treatment were retained. Though some died, many were LTF, lived within the community, and could develop and transmit resistant viral stains. Most traced patients were dead by the third month and poor contact information limited the effectiveness of tracing. Antiretroviral treatment programmes need to improve documentation processes and develop and implement tracing strategies.

show abstract

“…Onwujekwe et al, [50] Onwujekwe et al, [51] 2004 Cost analysis ITN distribution programmes 608 out of 798 people were hypothetically willing to pay for ITNs at a price of NGN350 ($US3.33); average stated WTP for ITNs ranged from NGN104.8 (most poor) to NGN230.3 (least poor); lower SES quintiles were less likely to have previously purchased untreated nets Alhasan et al, [52] 2008 Cost analysis Prostatectomy Cost of tx for BPH was $US615 per pt (range 300-1300)…”

Section: Continued Next Pagementioning

confidence: 99%

“…[20,[23][24][25]50] The highest number of articles published in a given year (n = 7) was in 2008, and the number of studies peaked from 2007 to 2009 (figure 2). There was an average of 3.68 years (SD 2.47; range [1][2][3][4][5][6][7][8][9][10][11] between the year of publication of the study and the last year of data collection.…”

Section: Extent and Trend Of Health Economic Studiesmentioning

confidence: 99%

The State of Health Economic Evaluation Research in Nigeria

et al. 2010

View full text Add to dashboard Cite

This study assessed the state of health economic evaluation (including pharmacoeconomic) research in Nigeria. A literature search was conducted to identify health economic articles pertaining to Nigeria. Two reviewers independently scored each article in the final sample using a data collection form designed for the study. A total of 44 studies investigating a wide variety of diseases were included in the review. These articles were published in 34 different journals, mostly based outside of Nigeria, between 1988 and 2009. On average, each article was written by four authors. Most first authors had medical/clinical affiliations and resided in Nigeria at the time of publication of the study. Based on a 1 to 10 scale, with 10 indicating the highest quality, the mean quality score for all studies was 7.29 (SD 1.21) and 59% of the articles were of fair quality (score 5-7); 5% were of even lower quality. The quality of articles was statistically significantly (p < or = 0.05) related to the country of residence of the primary author (non-Nigeria = higher), country of the journal (non-Nigeria = higher), primary objective of the study (economic analysis = higher) and type of economic analysis conducted (economic evaluations higher than cost studies). The conduct of health economic (including pharmacoeconomic) research in Nigeria was limited and about two-thirds of published articles were of sub-optimal quality. More and better quality health economic research in Nigeria is warranted.

show abstract

Examining catastrophic costs and benefit incidence of subsidized antiretroviral treatment (ART) programme in south-east Nigeria

Cited by 26 publications

References 8 publications

What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?

What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?

Retention and loss to follow-up in antiretroviral treatment programmes in southeast Nigeria

The State of Health Economic Evaluation Research in Nigeria

Contact Info

Product

Resources

About