The cost of providing hospital-based (early) antiretroviral treatment in Indonesia: what has changed in almost a decade?

Vadra, Jorghi; Komarudin, Dindin; Prawiranegara, Rozar; Lestari, Mery; Wisaksana, Rudi; Siregar, Adiatma Y. M.

doi:10.1080/09540121.2022.2113758

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…This situation is similar to a previous study in Indonesia on the cost of accessing HIV testing, in which clients with a higher monthly household expenditure had a higher access cost per visit [23], though variation may occur depending on the waiting and travel time, as well as transportation cost within the region [24]. However, in line with the newer study on ART in Indonesia, the client access cost does not reach 10% of the monthly household expenditure [19] and is not categorised as catastrophic spending [25]. As such, in terms of client access cost, in Indonesia, it seems that accessing PrEP should be feasible without a high access cost, although studies on a larger scale and/or in different settings are also needed.…”

Section: Discussionsupporting

confidence: 83%

“…Indonesia can potentially avert the largest number of new HIV infections averted among the men who have sex with men (MSM) group (51,500 new HIV infections) compared to China (36,000), India (6400), Thailand (1200), Vietnam (1200), Nepal (1000), Myanmar (1000), and Cambodia (700) [11]. From a societal perspective (i.e., healthcare plus non-healthcare costs), the estimated PrEP total cost is still 39% lower than the cost of ART per person per year in Indonesia, which is approximately US $600 [19]. Although our calculation did not include the cost of the outreach team, adding the cost of outreach per person per year reported in another study [20] (US $88.43, adjusted using 2022 exchange rate [21]), the cost of PrEP per person would reach US $453.46, still 24% lower than the cost of ART per person in Indonesia.…”

Section: Discussionmentioning

confidence: 99%

“…Reducing the price of ARV drugs will result in PrEP being potentially more cost-effective in Indonesia [11,[30][31][32][33]. Fortunately, the ARV drug price in Indonesia has decreased considerably within the last decade, and is estimated to be decreased by, on average, 40% for line 1 and 20% for line 2 [19,34]. As such, as the price of ARV drugs gets cheaper, the cost of providing PrEP will subsequently decrease, potentially increasing its cost-effectiveness.…”

Section: Discussionmentioning

confidence: 99%

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Cost of implementing HIV pre‐exposure prophylaxis at community‐based clinics in Indonesia

Siregar,

Juwita,

Hardiawan

et al. 2023

Tropical Med Int Health

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IntroductionCurrently, Indonesia still has one of the highest rates of new HIV/AIDS infections among countries in Asia and the Pacific region. The WHO has recommended pre‐exposure prophylaxis (PrEP) as an additional HIV epidemic prevention step, which has been applied globally and related to the reduction in the number of HIV cases. However, information on the cost of implementing PrEP is rarely available in developing countries, especially in Southeast Asia. Designing a cost‐effective approach to scale up PrEP and to estimate the potential budget impact requires information on the cost of implementing PrEP. This study aims to estimate the cost of implementing PrEP at community‐based clinics in Indonesia.MethodsWe collected healthcare and non‐healthcare/client costs from nine community‐based clinics in various cities/districts in Indonesia. The healthcare costs included data on resource utilisation and costs to deliver PrEP, divided into recurrent and capital costs using a discount rate of 3%. Non‐healthcare costs included out‐of‐pocket costs (e.g., transportation, meals) and productivity loss by clients and accompanying person(s) in accessing PrEP. On average, we interviewed 27 clients/clinic.ResultsThe annual cost of providing PrEP per client is US $365.03, 39% lower than the yearly cost of antiretroviral treatment (ART) per person (approximately US $600). Drugs and non‐healthcare costs contribute approximately 67% of the cost. The cost of PrEP amounts to US $292,756.45/year, covering 802 clients. The non‐healthcare cost per visit at all sites never reaches more than 10% of the average monthly household expenditure.ConclusionsThe cost of providing PrEP per person is approximately US $365 and is 39% lower than the annual cost of ART per person. Lowering the cost of PrEP ARV drugs would reduce the cost. Scaling up PrEP should recognise this cost structure and strive to reach economies of scale as the intervention gains more clients while simultaneously controlling new HIV infections.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cost of implementing HIV pre‐exposure prophylaxis at community‐based clinics in Indonesia

Siregar,

Juwita,

Hardiawan

et al. 2023

Tropical Med Int Health

Self Cite

View full text Add to dashboard Cite

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Costs and scale-up costs of community-based Oral HIV Self-Testing for female sex workers and men who have sex with men in Jakarta and Bali, Indonesia

Putri,

Ulandari,

Valerie

et al. 2024

BMC Health Serv Res

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Background The proportion of individuals who know their HIV status in Indonesia (66% in 2021) still remains far below the first 95% of UNAIDS 2030 target and were much lower in certain Key Populations (KPs) particularly Female Sex Workers (FSW) and Male having Sex with Male (MSM). Indonesia has implemented Oral HIV Self-testing (oral HIVST) through Community-based screening (HIV CBS) in addition to other testing modalities aimed at hard-to-reach KPs, but the implementation cost is still not analysed. This study provides the cost and scale up cost estimation of HIV CBS in Jakarta and Bali, Indonesia. Methods We estimated the societal cost of HIV CBS that was implemented through NGOs. The HIV CBS’s total and unit cost were estimated from HIV CBS outcome, health care system cost and client costs. Cost data were presented by input, KPs and areas. Health care system cost inputs were categorized into capital and recurrent cost both in start-up and implementation phases. Client costs were categorized as direct medical, direct non-medical cost and indirect costs. Sensitivity and scenario analyses for scale up were performed. Results In total, 5350 and 1401 oral HIVST test kits were distributed for HIV CBS in Jakarta and Bali, respectively. Average total client cost for HIV CBS Self testing process ranged from US$1.9 to US$12.2 for 1 day and US$2.02 to US$33.61 for 2 days process. Average total client cost for HIV CBS confirmation test ranged from US$2.83 to US$18.01. From Societal Perspective, the cost per HIVST kit distributed were US$98.59 and US$40.37 for FSW and MSM in Jakarta andUS$35.26 and US$43.31 for FSW and MSM in Bali. Conclusions CBS using oral HIVST approach varied widely along with characteristics of HIV CBS volume and cost. HIV CBS was most costly among FSW in Jakarta, attributed to the low HIV CBS volume, high personnel salary cost and client cost. Future approaches to minimize cost and/or maximize testing coverage could include unpaid community led distribution to reach end-users, integrating HIVST into routine clinical services via direct or secondary distribution and using social media network.

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The cost of providing hospital-based (early) antiretroviral treatment in Indonesia: what has changed in almost a decade?

Cited by 2 publications

References 11 publications

Cost of implementing HIV pre‐exposure prophylaxis at community‐based clinics in Indonesia

Cost of implementing HIV pre‐exposure prophylaxis at community‐based clinics in Indonesia

Costs and scale-up costs of community-based Oral HIV Self-Testing for female sex workers and men who have sex with men in Jakarta and Bali, Indonesia

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