South Africa has the world's largest number of patients on antiretroviral treatment (ART). As coverage expands beyond urban environments, the cost of care is becoming increasingly important.
Health care cost data for the first year after initiation were analyzed for cohorts of patients in a semiurban and an urban public sector ART clinic in South Africa. We compared mean cost by CD4 cell count and time on ART between clinics.
Patients in both clinics had comparable CD4 cell counts at initiation and under treatment. In the urban clinic, mean cost per patient-year on ART in 2011 USD was $1040 [95% confidence interval (CI): $800 to $1280], of which outpatient cost was $692 (67%) and inpatient cost was $348 (33%). Fourteen percent of urban patients required inpatient care at a mean length of stay of 9 days and mean cost per hospitalized patient of $1663 (95% CI: $1103 to $2041). In the semiurban clinic, mean cost per patient-year on ART was $1115 (95% CI: $776 to $1453), of which outpatient cost was $697 (63%) and inpatient cost $418 (37%). Seven percent of semiurban patients required inpatient care at a mean length of stay of 28 days and mean cost per hospitalized patient of $3824 (95% CI: $1143 to $6505).
Outpatient ART provision in the semiurban setting cost the same as in the urban setting, but inpatient costs are higher in the semiurban clinic because of longer hospitalizations. Cost in both clinics was highest in the first 3 months on ART and at CD4 cell counts <50 cells/μL.
*Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
†Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
‡Center for Global Health and Development, Boston University, Boston, MA
§Tshepong-Klerksdorp Hospital Complex, Klerksdorp, South Africa
‖Wits Institute for Reproductive Health and HIV, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Correspondence to: Gesine Meyer-Rath, MD, Health Economics and Epidemiology Research Office, Themba Lethu Wing, Helen Joseph Hospital, Perth Rd, Westdene, Johannesburg 2092, South Africa (e-mail: email@example.com).
G. Meyer-Rath's work on this study was funded by a research agreement under the Operational Plan for Comprehensive HIV and AIDS Care, Management, and Treatment of South Africa from the South African Department of Health and South African Medical Research Council and from a research agreement with the World Health Organization (obligation no. HQ/06/052223). W.D.F. Venter is supported by PEPFAR.
The authors have no other conflicts of interest to disclose.
Received February 3, 2012
Accepted July 31, 2012