The cost of HIV medication adherence support interventions: Results of a cross-site evaluation

Abstract

The objective of this study was to determine the direct cost of HIV adherence support programmes participating in a cross-site evaluation in the US. Data on the frequency, type, and setting of adherence encounters; providers' professions; and adherence tools provided were collected for 1,122 patients enrolled in 13 interventions at 9 sites. The site staff estimated the average duration of each type of encounter and national wage rates were used for labour costs. The median (range) adherence encounters/year among interventions was 16.5 (4.3-104.6) per patient; encounters lasted 24.6 (8.9-40.9) minutes. Intervention direct cost was correlated with the average frequency of encounters (r = 0.57), but not with encounter duration or providers' professions. The median direct cost/month was 35 dollars(5 dollars-58 dollars) per patient, and included direct provider costs (66%); incentives (17%); reminders and other tools (8%); and direct administrative time, provider transportation, training, and home delivery (9%). The median direct cost/month from a societal perspective, which includes patient time and travel costs, was 47 dollars(24 dollars-114 dollars) per patient. Adherence interventions with moderate efficacy costing < or =100 dollars/month have been estimated to meet a cost-effectiveness threshold that is generally accepted in the US. Payers should consider enhanced reimbursement for adherence support services.

“Payment by Results”—Financial Incentives and Motivational Interviewing, Adherence Interventions in Young Adults with Perinatally Acquired HIV-1 Infection: A Pilot Program

“…13,14 Current evidence suggests that economic incentives can aid behavioral change, including in adherence to medication and that cash/coupons have better effect than gifts/lottery and that earlier payment is associated with enhanced participation. [15][16][17][18] Financial incentives have been shown to improve adherence to antiretroviral therapy in HIV-positive methadone patients in the US, and mathematical modeling within this population suggests that adherence interventions with moderate effectiveness costing $100 per month or less are generally accepted to meet a cost-effective threshold. 10,14 Cost analysis of this small cohort showed that financial incentives linked to virological control are feasible and improve following cessation of the intervention with a total cost of £68 per 50 CD4 cells at 12 months reducing to £55 per 50 CD4 cells at 24 months.…”

Piloting a Peer-Driven Intervention Model to Increase Access and Adherence to Antiretroviral Therapy and HIV Care among Street-Entrenched HIV-Positive Women in Vancouver

“…Programs targeted at higher-risk individuals tend to be most costly. 31 The incentive promoted peer group attendance, cohesion, and a measure of stability, an important benefit to these PDI participants. For many women, the incentive and peer support group involvement also reduced their time engaged in survival sex work.…”

The Cost-Effectiveness of Counseling Strategies to Improve Adherence to Highly Active Antiretroviral Therapy among Men Who Have Sex with Men

“…For our base case estimate, we assumed that the counseling would be provided by a registered nurse (average national wage rate of $26.87/hour in 2004 (131)). Schackman et al (132) found that sessions provided by a registered nurse lasted 31.88 minutes on average, and that labor represented 65.7% of the total cost. Thus, we estimated the cost per counseling session to be (31.88/60)×($26.87)×(1/.657) = $21.73.…”