Cost-effectiveness analysis of the national decentralization policy of antiretroviral treatment programme in Zambia

Abstract

BackgroundIn resource-limited settings with a high prevalence of human immunodeficiency virus (HIV) infection such as Zambia, decentralization of HIV/acquired immunodeficiency syndrome (HIV/AIDS) treatment and care with effective use of resources is a cornerstone of universal treatment and care.ObjectivesThis research aims to analyse the cost effectiveness of the National Mobile Antiretroviral Therapy (ART) Services Programme in Zambia as a means of decentralizing ART services.MethodsCost-effectiveness analyses were performed using a decision analytic model and Markov model to compare the original ART programme, ‘Hospital-based ART’, with the intervention programme, Hospital-based plus ‘Mobile ART’, from the perspective of the district government health office in Zambia. The total cost of ART services, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were examined.ResultsThe mean annual per-patient costs were 1259.16 USD for the original programme and 2601.02 USD for the intervention programme, while the mean number of QALYs was 6.81 for the original and 7.27 for the intervention programme. The ICER of the intervention programme relative to the original programme was 2965.17 USD/QALY, which was much below the willingness-to-pay (WTP), or three times the GDP per capita (4224 USD), but still over the GDP per capita (1408 USD). In the sensitivity analysis, the ICER of the intervention programme did not substantially change.ConclusionThe National Mobile ART Services Programme in Zambia could be a cost-effective approach to decentralizing ART services into rural areas in Zambia. This programme could be expanded to more districts where it has not yet been introduced to improve access to ART services and the health of people living with HIV (PLHIV) in rural areas.Electronic supplementary materialThe online version of this article (doi:10.1186/s12962-017-0065-8) contains supplementary material, which is available to authorized users.

Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: A health economics modelling study

“…Most prior studies of DSD models have estimated either costs or outcomes, but not cost-effectiveness [ 9 ]. Two published studies evaluating cost-effectiveness of mobile ART services, which were both conducted several years ago, had mixed findings on cost-effectiveness, but both used higher annual per-patient costs than those for typical modern regimens from the universal test and treat era [ 10 , 11 ]. The objective of this study was to leverage recent outcomes from the DO ART study to parameterise a mathematical model and project population health impact, budget impact, and cost-effectiveness of scaling up community delivery of ART in KwaZulu-Natal, South Africa.…”

Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: a health economics modelling study

“…(9) Two published studies evaluating cost-effectiveness of mobile ART services had mixed findings on cost-effectiveness, but both used higher annual per-patient costs than those for typical modern regimens from the universal test and treat era. (10,11) The objective of this study was to leverage recent outcomes from the DO ART study to parameterise a mathematical model and project population health impact, budget impact, and cost-effectiveness of scaling up community delivery of ART in KwaZulu-Natal, South Africa. This study fills a key gap in the health economics literature on DSD models and community-based ART in particular.…”

VIBRA trial – Effect of village-based refill of ART following home-based same-day ART initiation vs clinic-based ART refill on viral suppression among individuals living with HIV: protocol of a cluster-randomized clinical trial in rural Lesotho

“…For patients who are stable on ART, decentralization of care to community-level and taskshifting to lay health workers has been shown to be feasible, cost-effective and acceptable. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] The WHO thus endorse recruitment of community health workers as a strategy to mitigate the impact of the severe shortage of nurses and doctors in rural Africa on health care coverage 43 and the UNAIDS launched a recruitment plan for 2 million community health workers in Africa to support its strategy. 44 Lesotho, a small land-locked country surrounded by South Africa, has the second-highest adult HIV prevalence globally (25.6%) with more than 70% of the population living in rural areas that are facing a shortage of doctors and nurses.…”