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Rates and Cost of Hospitalization Before and After Initiation of Antiretroviral Therapy in Urban and Rural Settings in South Africa

Meyer-Rath, Gesine MD*,†; Brennan, Alana T. MPH*,†; Fox, Matthew P. DSc*,†,‡; Modisenyane, Tebogo BSc§; Tshabangu, Nkeko RN§; Mohapi, Lerato MD§; Rosen, Sydney MPA*,†; Martinson, Neil MD, MPH§,‖

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1st, 2013 - Volume 62 - Issue 3 - p 322–328
doi: 10.1097/QAI.0b013e31827e8785
Brief Report: Clinical Science

Abstract: Few studies have compared hospitalizations before and after antiretroviral therapy (ART) initiation in the same patients. We analyzed the cost of hospitalizations among 3906 adult patients in 2 South African hospitals, 30% of whom initiated ART. Hospitalizations were 50% and 40% more frequent and 1.5 and 2.6 times more costly at a CD4 cell count <100 cells/mm3 when compared with 200–350 cells/mm3 in the pre-ART and ART period, respectively. Mean inpatient cost per patient year was USD 117 (95% confidence interval, 85 to 158) for patients on ART and USD 72 (95% confidence interval, 56 to 89) for pre-ART patients. Raising ART eligibility thresholds could avoid the high cost of hospitalization before and immediately after ART initiation.

*Center for Global Health and Development, Boston University, Boston, MA

Health Economics and Epidemiology Research Office, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Department of Epidemiology, Boston University School of Public Health, Boston, MA

§Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa

School of Medicine, Johns Hopkins University, Baltimore, MD.

Correspondence to: Gesine Meyer-Rath, MD, Health Economics and Epidemiology Research Office, Themba Lethu Wing, Helen Joseph Hospital, Perth Road, Westdene, Johannesburg, 2092, South Africa (e-mail:

Supported by the United States Agency for International Development (USAID) under an award to Boston University (674-A-00-09-00,018-00). Patient care was funded by the President’s Emergency Plan for AIDS Relief (PEPFAR), through USAID (674-A-00-05-00,003-00). M.P.F. was supported by a grant from the National Institute of Allergy and Infectious Diseases (NIAID) (K01AI083097). T.M. received research training funded by a Fogarty International Center grant (U2RTW007370/3). N.M. is partially funded by a grant from the National Institutes of Health (NIH) (R01HL090312).

Presented at the 15th International Workshop on HIV Observational Databases 2011, Prague, March 24, 2011 (Abstract no. 15_29) (closed meeting without publication).

The authors have no conflicts of interest to disclose. The opinions expressed herein are those of the authors and do not necessarily reflect the views of NIH, NIAID, USAID, PEPFAR, the University of the Witwatersrand, Boston University, or Johns Hopkins University.

G. Meyer-Rath and A.T. Brennan designed the study, analyzed and interpreted data, and wrote the first draft of the paper. M.P. Fox and S. Rosen contributed to data analysis and interpretation. T. Modisenyane and N. Tshabangu contributed to data acquisition and analysis. L. Mohapi contributed to data acquisition and interpretation. N. Martinson helped design the study and contributed to data interpretation. All authors helped draft and revise the article.

Meyer-Rath and Brennan share senior authorship.

Received May 29, 2012

Accepted November 16, 2012

© 2013 Lippincott Williams & Wilkins, Inc.