Costs of HIV/AIDS outpatient services delivered through Zambian public health facilities

Abstract

Summaryobjective To present evidence on unit and total costs of outpatient HIV ⁄ AIDS services in ZPCTsupported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV ⁄ AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother-tochild transmission (PMTCT) in Zambia.methods Cost data from 2008 were collected in 12 ZPCT-supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider. All shared costs were distributed to clinic visits using appropriate allocation variables. Estimates of annual costs of HIV ⁄ AIDS services were made using ZPCT and Ministry of Health data on numbers of persons receiving services in 2009.results Unit costs of visits were driven by costs of drugs, laboratory tests and clinical labour, while variability in visit costs across facilities was explained mainly by differences in utilization. First-year costs of ART per client ranged from US$278 to US$523 depending on drug regimen and facility type; costs of a complete course of antenatal care (ANC) including PMTCT were approximately US$114. Annual costs of ART provided in ZPCT-supported facilities were estimated at US$14.7-$40.1 million depending on regimen, and annual costs of antenatal care including PMTCT were estimated at US$16 million. In Zambia as a whole, the respective estimates were US$41.0-114.2 million for ART and US$57.7 million for ANC including PMTCT.conclusions Consistent with the literature, total costs of services were dominated by drugs, laboratory tests and clinical labour. For each visit type, variability across facilities in total costs and cost components suggests that some potential exists to reduce costs through greater harmonization of care protocols and more intensive use of fixed resources. Improving facility-level information on the costs of resources used to produce services should be emphasized as an element of health systems strengthening.keywords costs and cost analysis, human immunodeficiency virus, antiretroviral therapy, prevention of mother-to-child transmission, Zambia

Uptake, Outcomes, and Costs of Antenatal, Well-Baby, and Prevention of Mother-to-Child Transmission of HIV Services under Routine Care Conditions in Zambia

“…This figure is consistent with the $108–$120 per patient (in 2008 US dollars) for guideline-concordant care reported in the only other published study estimating costs of antenatal and PMTCT service delivery in Zambia, which was based on guidelines prior to the adoption of Option A [10]. Because the majority of mother/baby pairs in our sample did not receive all of the care recommended by guidelines, the actual cost of antenatal and PMTCT service provision was substantially less than $114.…”

“…Most published evidence on the implementation of PMTCT in Zambia and other countries in sub-Saharan Africa pertains to previous, less effective regimens [7], [8], [9], [10], [11], [12], [13]. Recently published papers on the cost-effectiveness of PMTCT in Nigeria, Malawi, Zimbabwe, and Rwanda draw data from multiple diverse sources and use models to estimate costs [14], [15], [16], [17].…”

Retention in Care and Outpatient Costs for Children Receiving Antiretroviral Therapy in Zambia: A Retrospective Cohort Analysis

“…Bratt et al estimated annual costs ranging from $278 to $523 (in 2008 US dollars) per patient for the first year on ART [17]. Tagar et al estimated an average cost of $278 per ART patient per year in 2010–2011 [18].…”

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

“…Second, the HIV epidemic in Zambia was characterized by a high prevalence of advanced disease (i.e., AIDS) and an under-developed health system in the early stages of the rapid scale-up of ART services beginning in 2004, which may have had unique effects on both program costs and health effects. However, we also performed a sensitivity analysis around the base ART cost estimate using recent systematic reviews from the region [18-21]. …”

“…While our primary cost estimate is similar to another recently published analysis from Zambia which found a cost of $518 to $523 per year for the use of efavirenz and non-generic tenofovir and emtricitabine (the recommended first-line NRTI combination in Zambia since 2007), there was also a high degree of heterogeneity in the average total (i.e., on site and off site) cost at the 45 sites used to derive our estimates, which explained 78% and 66% of the variation of average total and on-site costs respectively [16,18]. For this reason, we also conducted a sensitivity analysis incorporating cost estimates from recent systematic reviews of similar low income countries [20,21].…”