Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study

Abstract

BackgroundIt is anticipated that demands on ambulatory HIV services will increase in coming years as a consequence of the increased life expectancy of HIV patients on highly active anti-retroviral therapy (HAART). Accurate cost data are needed to enable evidence based policy decisions be made about new models of service delivery, new technologies and new medications.MethodsA micro-costing study was carried out in an HIV outpatient clinic in a single regional centre in the south of Ireland. The costs of individual appointment types were estimated based on staff grade and time. Hospital resources used by HIV patients who attended the ambulatory care service in 2012 were identified and extracted from existing hospital systems. Associations between patient characteristics and costs per patient month, in 2012 euros, were examined using univariate and multivariate analyses.ResultsThe average cost of providing ambulatory HIV care was found to be €973 (95% confidence interval €938 - €1008) per patient month in 2012. Sensitivity analysis, varying the base-case staff time estimates by 20% and diagnostic testing costs by 60%, estimated the average cost to vary from a low of €927 per patient month to a high of €1019 per patient month. The vast majority of costs were due to the cost of HAART. Women were found to have significantly higher HAART costs per patient month while patients over 50 years of age had significantly lower HAART costs using multivariate analysis.ConclusionsThis study provides the estimated cost of ambulatory care in a regional HIV centre in Ireland. These data are valuable for planning services at a local level, and the identification of patient factors, such as age and gender, associated with resource use is of interest both nationally and internationally for the long-term planning of HIV care provision.

The impact of socioeconomic factors on the healthcare costs of people living with HIV in Turkey

“…This finding is consistent with previous works demonstrating that women are more prone to the risks of HIV infection compared to men [28][29][30]. Prior research also argues that women have better health maintenance compared to men and have greater utilisation of healthcare services [31][32][33][34].…”

“…Compared to people who were recently diagnosed with HIV, people who were diagnosed ≥10 years ago have $743 lower expenditures on average. This may be due to the improvements in CD4 count with the number of years from diagnosis [31].…”

“…Female healthcare costs are higher as opposed to male health care costs. Prior research also argues that women have better health maintenance compared to men and have greater utilisation of healthcare services [28][29][30][31][32][33][34]. Marriage increases the costs; the odds of HIV infection are higher for married women as they cannot refuse sex and ask for condom use in marriage.…”

“…The duration of treatment lowers the expenditures. This may be due to the improvements in CD4 count with the number of years from diagnosis [31].…”

The Economic Burden of Asthma in the United States, 2008–2013

“…The authors of that study used a gross-costing method that was based on healthcare use and average per-unit cost data (17)(18)(19)(20)(21)(22). The cost of asthma-related hospitalizations, for example, was estimated by multiplying the number of asthma hospitalizations by the average cost for one hospitalization (7,23).…”