Costing universal access of highly active antiretroviral therapy in Benin

Hounton, Sennen; Akonde, Alain; Zannou, Djimon Marcel; Bashi, Jules; Méda, Nicolas; Newlands, David

doi:10.1080/09540120701868303

Cited by 20 publications

(14 citation statements)

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“…The lower average direct costs in our study compared with the findings in Chad were mainly due to inclusion of both AIDS and non-AIDS respondents. However, a study conducted in Benin reported almost half the costs to access the package of care for ART therapy, than those from our own study findings [38]. The higher direct costs in our study than the study in Benin may be due to methodological differences, as they assessed the costs only to get ART medicine, unlike in our study.…”

Section: Discussioncontrasting

confidence: 80%

The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study

Poudel

Newlands

Simkhada

2017

BMC Health Serv Res

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BackgroundThere have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Therefore, this study explores in detail the economic burden of HIV/AIDS, including direct costs and productivity costs. This paper focuses on the direct costs of seeking treatment, productivity costs, and related factors affecting direct costs, and productivity costs.MethodsThis study was a cross-sectional, quantitative study. The primary data were collected through a structured face-to-face survey from 415 people living with HIV/AIDS (PLHIV). The study was conducted in six representative treatment centres of six districts of Nepal. The data analysis regarding the economic burden (direct costs and productivity costs) was performed from the household’s perspective. Descriptive statistics have been used, and regression analyses were applied to examine the extent, nature and determinants of the burden of the disease, and its correlations.ResultsAverage total costs due to HIV/AIDS (the sum of average total direct and average productivity costs before adjustment for coping strategies) were Nepalese Rupees (NRs) 2233 per month (US$ 30.2/month), which was 28.5% of the sample households’ average monthly income. The average total direct costs for seeking HIV/AIDS treatment were NRs 1512 (US$ 20.4), and average productivity costs (before adjustment for coping strategies) were NRs 721 (US$ 9.7). The average monthly productivity losses (before adjustment for coping strategies) were 5.05 days per person. The major determinants for the direct costs were household income, occupation, health status of respondents, respondents accompanied or not, and study district. Health status of respondents, ethnicity, sexual orientation and study district were important determinants for productivity costs.ConclusionsThe study concluded that HIV/AIDS has caused a significant economic burden for PLHIV and their families in Nepal. The study has a number of policy implications for different stakeholders. Provision of social support and income generating programmes to HIV-affected individuals and their families, and decentralising treatment services in each district seem to be viable solutions to reduce the economic burden of HIV-affected individuals and households.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-1976-y) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 80%

The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study

Poudel

Newlands

Simkhada

2017

BMC Health Serv Res

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“…[22, 24–28] Studies for lower-middle-income countries (LMIC) were found for India [29, 30] , Lesotho [18] , Morocco [31] , Nigeria [32, 33] , and Thailand [34] ; the median cost of ART was $932 (mean $1,246, range $156 to $3,904) (tables II & IV). In upper-middle-income countries (UMIC), Brazil [23, 35] , Mexico [36–38] and South Africa [21, 39–45] the median ART cost was $1,454 (mean $2,783; range $1,230 to $5,667) (tables III & IV).…”

Section: Resultsmentioning

confidence: 99%

Unit Costs for Delivery of Antiretroviral Treatment and Prevention of Mother-to-Child Transmission of HIV

et al. 2011

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Background As antiretroviral treatment (ART) for HIV/AIDS is scaled-up globally, information on per-person costs is critical to improve efficiency in service delivery and maximize coverage and health impact. Objective To review studies on delivery unit costs for adult and pediatric ART provision per-patient-year, and prevention of mother-to-child transmission (PMTCT) interventions per mother-infant pair screened or treated, in low- and middle-income countries. Methods Systematic review of English, French and Spanish publications from 2001 to 2009, reporting empirical costing that accounted for at least antiretroviral (ARV) medicines, laboratory testing and personnel. Expenditures were analyzed by country income level and cost component. All costs were standardized to 2009 US dollars. Results Analyses covered 29 eligible, comprehensive costing studies. In the base case, in low-income countries (LIC), median, ART cost per patient-year was $792 (mean: $839, range: $682-$1089); for lower-middle-income countries (LMIC), the median was $932 (mean: $1246, range: $156-$3904); and for upper-middle-income countries (UMIC) the median was $1454 (mean: $2783, range: $1230-$5667). ARV drugs were largest component of overall ART cost in all settings (62%, 50% and 47% in LIC, LMIC and UMIC respectively). Out of 26 ART studies, 14 report which drug regimes were used, and only one study explicitly reported second line treatment costs. The second cost driver was laboratory cost in LIC and LMIC (14% and 19.5%) whereas it was personnel costs in UMIC (26%). Two studies specified the types of laboratory tests costed, and three studies specifically included above-facility-level personnel costs. Three studies reported detailed PMTCT costs, and two studies reported on pediatric ART. Conclusions There is a paucity of data on the full ART and PMTCT delivery unit costs, in particular for low-and middle-income countries. Heterogeneity in activities costed and insufficient detail regarding components included in the costing hampers standardization of unit cost measures. Evaluation of program-level unit costs would benefit from international guidance on standardized costing methods, and expenditure categories and definitions. Future work should help elucidate the sources for the large variations in delivery unit costs across settings with similar income and epidemiological characteristics.

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“…This, coupled with the good biological and behavioural results seen in our cohort, suggests that this intervention may be cost-effective. The cost of this important intervention should, therefore, not be a prohibitive factor in scaling it up across Burkina Faso and elsewhere with the average costs likely to decrease as this is done [42], [43]. Of priority now, is combining impact evaluation to our cost data to determine the cost-effectiveness of such an intervention.…”

Section: Discussionmentioning

confidence: 99%

The Cost of Providing Combined Prevention and Treatment Services, Including ART, to Female Sex Workers in Burkina Faso

et al. 2014

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BackgroundFemale Sex workers (FSW) are important in driving HIV transmission in West Africa. The Yerelon clinic in Burkina Faso has provided combined preventative and therapeutic services, including anti-retroviral therapy (ART), for FSWs since 1998, with evidence suggesting it has decreased HIV prevalence and incidence in this group. No data exists on the costs of such a combined prevention and treatment intervention for FSW. This study aims to determine the mean cost of service provision per patient year for FSWs attending the Yerelon clinic, and identifies differences in costs between patient groups.MethodsField-based retrospective cost analyses were undertaken using top-down and bottom-up costing approaches for 2010. Expenditure and service utilisation data was collated from primary sources. Patients were divided into groups according to full-time or occasional sex-work, HIV status and ART duration. Patient specific service use data was extracted. Costs were converted to 2012 US$. Sensitivity analyses considered removal of all research costs, different discount rates and use of different ART treatment regimens and follow-up schedules.ResultsUsing the top-down costing approach, the mean annual cost of service provision for FSWs on or off ART was US$1098 and US$882, respectively. The cost for FSWs on ART reduced by 29%, to US$781, if all research-related costs were removed and national ART monitoring guidelines were followed. The bottom-up patient-level costing showed the cost of the service varied greatly across patient groups (US$505–US$1117), primarily due to large differences in the costs of different ART regimens. HIV-negative women had the lowest annual cost at US$505.ConclusionWhilst FSWs may require specialised services to optimise their care and hence, the public health benefits, our study shows that the cost of ART provision within a combined prevention and treatment intervention setting is comparable to providing ART to other population groups in Africa.

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Costing universal access of highly active antiretroviral therapy in Benin

Cited by 20 publications

References 10 publications

The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study

The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study

Unit Costs for Delivery of Antiretroviral Treatment and Prevention of Mother-to-Child Transmission of HIV

The Cost of Providing Combined Prevention and Treatment Services, Including ART, to Female Sex Workers in Burkina Faso

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