Costs and cost-effectiveness of HIV/noncommunicable disease integration in Africa

Abstract

: The current article reviews economic aspects of selected HIV/noncommunicable disease (NCD) service delivery integration programs to assess the efficiency of integration in limited capacity settings. We define economies of scope and scale and their relevance to HIV/NCD integration. We summarize the results of a systematic review of cost and cost-effectiveness studies of integrated care, which identified 12 datasets (nine studies) with a wide range of findings driven by differences in research questions, study methods, and health conditions measured. All studies were done in Africa and examined screening interventions only. No studies assessed the cost of integrated, long-term disease management. Few studies estimated the cost-effectiveness of integrated screening programs. The additional cost of integrating NCD screening with HIV care platforms represented a 6-30% increase in the total costs of the programs for noncancer NCDs, with cervical cancer screening costs dependent on screening strategy. We conducted 11 key informant interviews to uncover perceptions of the economics of HIV/NCD integration. None of the informants had hard information about the economic efficiency of integration. Most expected integrated care to be more cost-effective than current practice, though a minority thought that greater specialization could be more cost-effective. In the final section of this article, we summarize research needs and propose a 'minimum economic dataset' for future studies. We conclude that, although integrated HIV/NCD care has many benefits, the economic justification is unproven. Better information on the cost, cost-effectiveness, and fiscal sustainability of integrated programs is needed to justify this approach in limited-resource countries.

Systems analysis and improvement approach to optimize the hypertension diagnosis and care cascade for PLHIV individuals (SAIA-HTN): a hybrid type III cluster randomized trial

“…We will use the organizational readiness for implementing change (ORIC) scale to assess facility readiness for SAIA-HTN adoption [50,51]. Cost-effective analyses rarely assess CVD management strategies among PLHIV, and more research is needed [65]. This study will model long-term outcomes (DALYs) to capture the minimum data set for economic evaluation recently developed for researchers studying HIV/NCD integration [65].…”

“…Cost-effective analyses rarely assess CVD management strategies among PLHIV, and more research is needed [65]. This study will model long-term outcomes (DALYs) to capture the minimum data set for economic evaluation recently developed for researchers studying HIV/NCD integration [65]. State of the art implementation science methods strengthen our evaluative framework for multi-level, theory-based adaptation of interventions, and exploits outcome heterogeneity to assess implementation barriers and facilitators.…”

Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Case Cascade for PLHIV Individuals (SAIA-HTN): A Hybrid Type III Cluster Randomized Trial

“…[50,51] Cost effective analyses rarely assess CVD management strategies among PLHIV, and more research is needed. [65] This study will model long-term outcomes (DALYs) to capture the minimum data set for economic evaluation recently developed for researchers studying HIV/NCD integration.…”

Cost‐effectiveness analysis of integrating screening and treatment of selected non‐communicable diseases into HIV/AIDS treatment in Uganda

“…Therefore, integration of routine screening and management of NCDs in HIV care and treatment settings offers an opportunity to curb the emerging NCD crisis that could otherwise jeopardize the health and economic benefits reaped through ART scale-up. Indeed, integrating selected NCD services into ART delivery could leverage the past investments made towards HIV services to, additionally and effectively, deliver NCD treatment services and further reduce preventable deaths among PLWH by achieving economies of scope [22,23].…”

“…In integrating screening and treatment of basic NCDs into ART delivery in SSA, the little evidence available so far supports the selection of appropriate NCD interventions to be added to current ART delivery practices. A few studies have examined the clinical benefits and cost implications of fully integrating screening, treatment and long-term monitoring of risk factors like hypertension and hypercholesterolaemia among HIV-infected patients [22][23][24]. A number of economic evaluations have also studied integrating NCD and HIV services; yet, they are often limited to screening and identifying basic risk factors, like hypertension, without covering the full cascade of NCD treatment (e.g.…”