The cost effectiveness of home-based provision of antiretroviral therapy in rural Uganda

Abstract

Context-Highly active anti-retroviral therapy (ART) provides dramatic health benefits for HIVinfected individuals in Africa, and widespread implementation of HAART is proceeding rapidly. Little is known about the cost and cost-effectiveness of HAART programs.Objective-To determine the incremental cost-effectiveness of a home-based HAART program in rural Uganda.Design, setting and patients-Computer-based, deterministic cost-effectiveness model to assess a broad range of economic inputs and health outcomes. From the societal perspective we compared the cost-effectiveness of HAART and cotrimoxazole prophylaxis with cotrimoxazole alone, and with the period before either intervention. Data for 24 months were derived from a trial of HAART in 1,045 patients in Tororo District in eastern Uganda. Costs and outcomes were projected out to 15 years. All costs are in 2004 U.S. dollars.Interventions-First-line HAART regimen consisted of standard doses of stavudine, lamivudine, and either nevirapine or, for clients with active tuberculosis, efavirenz. Second-line therapy consisted of tenofovir, didanosine, and lopinavir/ritonavir. For children, first-line HAART consisted of Correspondence to: Dr. Elliot Marseille, Health Strategies International, 1743 Carmel Drive #26, Walnut Creek, CA 94596, USA, Ph: +1-925-392-4444, emarseille@comcast.net. Conflict of Interest StatementAll authors declare that they have not conflicts of interest to declare. We will provide signed statements to that effect as needed. Contributor shipElliot Marseille (First author): Concept, Design, Parameter estimation, Literature review, Analysis, Writing. Dr. Marseille had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Ethical approvalNo ethical approval was required for this research. NIH Public Access Author ManuscriptAppl Health Econ Health Policy. Author manuscript; available in PMC 2010 July 29. Published in final edited form as:Appl Health Econ Health Policy. 2009 ; 7(4): 229-243. doi:10.2165/11318740-000000000-00000. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript zidovudine, lamivudine and nevirapine syrup; second-line therapy was stavudine, didanosine and lopinavir/ritonavir.Main outcome measures-HAART program costs, the health benefits accruing to HAART recipients, averted HIV infections in adults and children, and resulting effects on medical care costs.Results-The HAART program standardized for 1,000 patients cost an incremental $1.39 million in its first two years. Compared with cotrimoxazole prophylaxis alone, the program reduced mortality by 87%, and averted 6,861 incremental disability adjusted life-years (DALYs). Benefits accrued from reduced mortality in HIV-infected adults, (67.5% of all benefits), prevention of death in HIVnegative children (20.7%), averted HIV infections in adults (9.1%) and children (1.0%), and improved health status (1.7%). The net program cost, including the medical cost implications of these ...

Cost and cost threshold analyses for 12 innovative US HIV linkage and retention in care programs

“…Several studies have shown the cost-effectiveness of HIV linkage and retention in care programs implemented in the USA (Creese, Floyd, Alban, & Guinness, 2002;Hogan, Baltussen, Hayashi, Lauer, & Salomon, 2005;Holtgrave, 1998;Kim et al, 2015;Losina et al, 2009;Marseille et al, 2009Marseille et al, , 2012Renaud, Basenya, De Borman, Greindl, & Meyer-Rath, 2009;Walker, 2003). The evaluators of Health Resources and Services Administration's Special Projects of National Significance found program costs of $241,565 ($393 per patient) (Gopalappa, Farnham, Hutchinson, & Sansom, 2012).…”

Cost-Effectiveness of Improving Health Care to People with HIV in Nicaragua

“…It is likely that the decrease in opportunistic infections and hospitalization and the improvement in clinical status had a positive economic impact on patients and their families due to their improved overall functioning possibly allowing for more time for employment and other productive economic activities. This has been the case in other studies that have examined cost-effectiveness of treatments to improve the health of patients with HIV [26, 27]. In this study, the factor was not measured because we considered only the perspective of the MINSA, the caregivers, and HCI.…”

Estimating the cost-effectiveness of nutrition supplementation for malnourished, HIV-infected adults starting antiretroviral therapy in a resource-constrained setting

“…Treatment with ART was estimated to avert 7.3 discounted DALYs among HIV-infected individuals who survived >16 weeks. This value was drawn from the same Zambian analysis used to estimate treatment costs, and it was obtained by comparing deaths in the Zambian ART program with deaths observed in a prior, well-characterized home-based AIDS care (HBAC) cohort of 466 HIV-infected patients not receiving ART in Tororo District, Uganda, adjusted for differences in CD4+ T-cell counts and sex distribution between groups [16,19,24,25]. …”