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The Evolving Cost of HIV in South Africa: Changes in Health Care Cost With Duration on Antiretroviral Therapy for Public Sector Patients

Harling, Guy MA, MPH; Wood, Robin FCP(SA)

JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1st, 2007 - Volume 45 - Issue 3 - p 348-354
doi: 10.1097/QAI.0b013e3180691115
Epidemiology and Social Science

A retrospective costing study of 212 patients enrolled in a nongovernmental organization-supported public sector antiretroviral treatment (ART) program near Cape Town, South Africa was performed from a health care system perspective. γ-Regression was used to analyze total costs in 3 periods: Pre-ART (median length = 30 days), first 48 weeks on ART (Year One), and 49 to 112 weeks on ART (Year Two). Average cost per patient Pre-ART was $404. Average cost per patient-year of observation was $2502 in Year One and $1372 in Year Two. The proportion of costs attributable to hospital care fell from 70% Pre-ART to 24% by Year Two; the proportion attributable to ART rose from 31% in Year One to 55% in Year Two. In multivariate analysis, Pre-ART and Year One costs were significantly lower for asymptomatic patients compared with those with AIDS. Costs were significantly higher for those who died Pre-ART or in Year One. In Year Two, only week 48 CD4 cell count and being male were significantly associated with lower costs. This analysis suggests that the total cost of treatment for patients on ART falls by almost half after 1 year, largely attributable to a reduction in hospital costs.

From the Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Received for publication December 14, 2006; accepted April 6, 2007.

G. Harling receives support from the City Bridge Foundation. R. Wood receives partial support from National Institutes of Health (NIH) CIPRA grant 1U19AI053217-01 and from NIH grant R01AI058736-01A1.

Reprints: Guy Harling, MA, MPH, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa (e-mail: guy.harling@gmail.com).

© 2007 Lippincott Williams & Wilkins, Inc.