The cost of care for people living with stable HIV in Croatia and the efficiency of EmERGE

Abstract

Aim To estimate the cost-effectiveness of the EmERGE Pathway of Care for medically stable people living with HIV (PLHIV) at the University Hospital for Infectious Diseases (UHID), Zagreb. The Pathway includes a mobile application enabling individuals to communicate with their caregivers. Methods This study involving 293 participants collected data on the use of HIV outpatient services one year before and after EmERGE implementation. In departments supporting HIV outpatients, a micro-costing exercise was performed to calculate unit costs. These were combined with mean use of HIV services per patient year (MPPY) to estimate average annual costs. Primary outcomes were CD4 count, viral load, and secondary outcomes were patient activation, PAM13; and quality of life, PROQOL-HIV. Information on out-of-pocket expenditures was also collected. Results Outpatient visits decreased by 17%, from 4.0 (95% CI 3.8-4.3) to 3.3 MPPY (95% CI 3.1-3.5). Tests, including CD4 count, decreased, all contributing to a 33% reduction of annual costs: 7139 HRK (95% CI 6766-7528) to 4781 HRK (95% CI 4504-5072). Annual costs including anti-retroviral drugs (ARVs) decreased by 5%: 43 101 HRK (95% CI 42 728-43,490) to 40 743 HRK (95% CI 40 466-41,034). ARVs remain the main cost driver in stable PLHIV. Primary and secondary outcomes did not change substantially between periods. Conclusion EmERGE Pathway was a cost-saving intervention associated with changes in management, and a reduction in outpatient visits, tests, and costs. ARV costs dominated costs. Future efficiencies are possible if EmERGE is introduced to other PLHIV across the UHID and if ARV prices are reduced.

The Management of HIV Care Services in Central and Eastern Europe: Data from the Euroguidelines in Central and Eastern Europe Network Group

“…Although challenging, telehealth could be an opportunity to accelerate communication with patients from rural areas who are unable to travel due to work, family duties, or disability. While face-to-face patient-physician meetings are essential for HIV medical care, especially at the beginning of the diagnosis process, this could be combined with telehealth later in the care process [26,27]. Although some studies show that personal contact with patients significantly improves visit adherence and promotes better relationships with the therapeutic team in primary care, they do not compare this contact with specific telehealth tools as an alternative option [28,29].…”

The efficiency of the EmERGE platform for medically stable people living with HIV in Portugal

“…This difference is accentuated if costs are converted to gross domestic product (purchasing parity prices), an index of a country's wealth 39 : Once transformed, the annual cost of ARVs in Lisbon was US$17,230, compared with US$9,595 to US$11,586 per annum for the other sites. 40 Costing Hospital Capuchos was a complex exercise, and this complexity limited the use of the bottom-up method and thereby the granularity of the analyses. Although EmERGE participants were followed up at the Hospital Capuchos, some of the laboratories or overhead services that supported the outpatient services used by EmERGE participants were located at other CHLC sites.…”

The efficiency of the EmERGE pathway to provide continuity of care for medically stable people living with HIV in Belgium

“…As the primary and secondary outcome measures did not change substantially, the introduction of the new Pathway, minimized the cost of providing the outpatient service. The introduction of the Pathway in each of the other four EmERGE sites, also resulted in similar cost reductions [40][41][42] Participants remained immunologically and virologically stable after the introduction of the mHealth App, with no substantive changes in patient activation, mental health or quality of life [43]. Extending the use of the Pathway to all PLHIV, could increase the savings made.…”

“…The EmERGE study was successfully implemented in five different European countries, which demonstrates its applicability in different cultural settings and different health care systems and countries [40][41][42] So far it only involved medically stable PLHIV and follow-up was still relatively short.…”