Costs of medical services for patients with HIV/AIDS in Khon Kaen, Thailand

Kitajima, Tsutomu; Kobayashi, Yasuki; Chaipah, Weerasak; Sato, Hajime; Chadbunchachai, Witaya; Thuennadee, Ruengsin

doi:10.1097/00002030-200311070-00013

Cited by 18 publications

(10 citation statements)

References 13 publications

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“…The cost per outpatient hospital visit for PLWH in Thailand was $27 [53], again very close to the cost per ProTEST clinic visit. The daily cost of hospice care is shown to be within the range of in-patient hospital cost for AIDS patients in low-income African countries, ranging from $9 to $49.…”

Section: Discussionmentioning

confidence: 91%

Integrating tuberculosis and HIV services for people living with HIV: Costs of the Zambian ProTEST Initiative

Terris‐Prestholt

Kumaranayake

Ginwalla

et al. 2008

Cost Eff Resour Alloc

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BackgroundIn the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH) in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT) acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC), and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy.MethodsAnnual financial and economic providers costs and output measures were collected in 2000–2001. Estimates are made of total costs for each component and average costs per: person reached by ProTEST; VCT pre-test counselled, tested and completed; isoniazid preventive therapy started and completed; clinic visit; HBC patient; and hospice admission and bednight.ResultsAnnual core ProTEST costs were (in 2007 US dollars) $84,213 in Chawama and $31,053 in Matero. The cost of coordination was 4%–5% of total site costs ($1–$6 per person reached). The largest cost component in Chawama was voluntary counselling and testing (56%) and the clinic in Matero (50%), where VCT clients had higher HIV-prevalences and more advanced HIV. Average costs were lower for all components in the larger site. The cost per HBC patient was $149, and per hospice bednight was $24.ConclusionThis study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.

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Section: Discussionmentioning

confidence: 91%

Integrating tuberculosis and HIV services for people living with HIV: Costs of the Zambian ProTEST Initiative

Terris‐Prestholt

Kumaranayake

Ginwalla

et al. 2008

Cost Eff Resour Alloc

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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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“…While this has led to reduced hospitalization costs, ART has become the main driver of the total cost of caring for PLWHA. This represents a challenge in low-income countries [ 3 ], emerging economies [ 4 , 5 ] as well as in developed countries [ 6 , 7 ]. The price of HIV care can quickly become a considerable economic burden especially in settings where all drugs are not available free of charge, where they remain on charge by the patients or where direct out of pocket payments (OOPs) are required [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Evidence of High Out of Pocket Spending for HIV Care Leading to Catastrophic Expenditure for Affected Patients in Lao People's Democratic Republic

et al. 2015

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BackgroundThe scaling up of antiviral treatment (ART) coverage in the past decade has increased access to care for numerous people living with HIV/AIDS (PLWHA) in low-resource settings. Out-of-pocket payments (OOPs) represent a barrier for healthcare access, adherence and ART effectiveness, and can be economically catastrophic for PLWHA and their family. We evaluated OOPs of PLWHA attending outpatient and inpatient care units and estimated the financial burden for their households in the Lao People's Democratic Republic. We assumed that such OOPs may result in catastrophic health expenses in this context with fragile economical balance and low health insurance coverage.MethodsWe conducted a cross-sectional survey of a randomized sample of routine outpatients and a prospective survey of consecutive new inpatients at two referral hospitals (Setthathirat in the capital city, Savannaket in the province). After obtaining informed consent, PLWHA were interviewed using a standardized 82-item questionnaire including information on socio-economic characteristics, disease history and coping strategies. All OOPs occurring during a routine visit or a hospital stay were recorded. Household capacity-to-pay (overall income minus essential expenses), direct and indirect OOPs, OOPs per outpatient visit and per inpatient stay as well as catastrophic spending (greater than or equal to 40% of the capacity-to-pay) were calculated. A multivariate analysis of factors associated with catastrophic spending was conducted.ResultsA total of 320 PLWHA [280 inpatients and 40 outpatients; 132 (41.2%) defined as poor, and 269 (84.1%) on ART] were enrolled. Monthly median household income, essential expenses and capacity-to-pay were US$147.0 (IQR: 86–242), $126 (IQR: 82–192) and $14 (IQR: 19–80), respectively. At the provincial hospital OOPs were higher during routine visits, but three fold lower during hospitalization than in the central hospital ($21.0 versus $18.5 and $110.8 versus $329.8 respectively (p<0.01). The most notable OOPs were related to transportation and to loss of income. A total of 150 patients (46.8%; 95%CI: 41.3–52.5) were affected by catastrophic health expenses; 36 outpatients (90.0%; 95%CI: 76.3–97.2) and 114 inpatients (40.7%; 95%CI: 34.9–46.7). A total of 141 (44.0%) patients had contracted loans, and 127 (39.6%) had to sell some of their assets. In the multivariate analysis, being of Lao Loum ethnic group (Coef.-1.4; p = 0.04); being poor (Coef. -1.0; p = 0.01) and living more than 100 km away from the hospital (Coef.-1.0; p = 0.002) were positively associated with catastrophic spending. Conversely being in the highest wealth quartile (Coef. 1.6; p<0.001), living alone (Coef. 1.1; p = 0.04), attending the provincial hospital (Coef. 1.0; p = 0.002), and being on ART (Coef.1.2; p = 0.003), were negatively associated with catastrophic spending.ConclusionPLWHA’s households face catastrophic OOPs that are not directly attributable to the cost of ART or to follow-up tests, particularly during a hospitalization period. Transpo...

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Costs of medical services for patients with HIV/AIDS in Khon Kaen, Thailand

Cited by 18 publications

References 13 publications

Integrating tuberculosis and HIV services for people living with HIV: Costs of the Zambian ProTEST Initiative

Integrating tuberculosis and HIV services for people living with HIV: Costs of the Zambian ProTEST Initiative

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

Evidence of High Out of Pocket Spending for HIV Care Leading to Catastrophic Expenditure for Affected Patients in Lao People's Democratic Republic

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