Costs of HIV/AIDS Treatment in Indonesia By Time of Treatment & Stage of Disease

We report an economic analysis of Human Immunodeficiency Virus (HIV) care and treatment in Indonesia to assess the options and limitations of costs reduction, improving access, and scaling up services.

We calculated the cost of providing HIV care and treatment in a main referral hospital in West Java, Indonesia from 2008 to 2010, differentiated by initiation of treatment at different CD4 cell count levels (0–50, 50–100, 100–150, 150–200, and >200 cells/mm ³ ); time of treatment; HIV care and opportunistic infections cost components; and the costs of patients for seeking and undergoing care.

Before antiretroviral treatment (ART) initiation, costs were dominated by laboratory tests (>65 %), and after initiation, by antiretroviral drugs (≥60 %). Average treatment costs per patient decreased with time on treatment (e.g. from US$580 per patient in the first 6 month to US$473 per patient in months 19–24 for those with CD4 cell counts under 50 cells/mm ³ ). Higher CD4 cell counts at initiation resulted in lower laboratory and opportunistic infection treatment costs. Transportation cost dominated the costs of patients for seeking and undergoing care (>40 %).

Costs of providing ART are highest during the early phase of treatment. Costs reductions can potentially be realized by early treatment initiation and applying alternative laboratory tests with caution. Scaling up ART at the community level in certain high prevalence settings may improve early uptake, adherence, and reduce transportation costs.

Below: Average service costs per patient per specified period, health care system perspective (US$). This figure presents the average service costs per patient taking ART. The average costs are separated into specific periods, namely before ART, 1–6 months, 7–12 months, 13–18 months, and 19–24 months within ART. These costs are further separated into CD4 cell count group, namely 0–50, 50–100, 100–150, 150 - 200, and >200 cells/mm 3 . The figure shows how the average costs per patient in different CD4 cell count groups relatively decrease after the start of ART

Below:  Appendix (Figure A). HIV treatment total costs per patient on ART, over 24 months. This figure shows the scatter diagram of total costs of patients undertaking HIV treatment over 24 months. The patients within the group of 0–50 cells/mm ³ CD4 cell count have the largest variance in costs (e.g. patients with highest or lowest average treatment costs are within this group)

Full article at:  http://ht.ly/SSuNB 

By: Adiatma Y. M. Siregar^12*, Noor Tromp¹³, Dindin Komarudin¹, Rudi Wisaksana¹⁴, Reinout van Crevel¹⁵, Andre van der Ven¹⁵ and Rob Baltussen¹³

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