Cost-Effectiveness and Quality of Care of a Comprehensive ART Program in Malawi
| Autor: | Sandro Mancinelli, Giuseppe Liotta, Lauren Shear Zimmer, M. Sundaram, Stefano Orlando, Samantha Diamond, Maria Cristina Marazzi, Leonardo Palombi |
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| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Gerontology medicine.medical_specialty Monitoring Total cost Cost effectiveness Anti-HIV Agents Settore MED/42 - Igiene Generale e Applicata Cost-Benefit Analysis HIV Infections Gross domestic product Medication Adherence 03 medical and health sciences 0302 clinical medicine Patient Education as Topic Per capita Medicine Humans 030212 general & internal medicine Physiologic health care economics and organizations Cost database Monitoring Physiologic Quality of Health Care Cost–benefit analysis business.industry Economic Evaluation Study General Medicine Viral Load medicine.disease 030112 virology Quality-adjusted life year CD4 Lymphocyte Count Patient Care Management Malnutrition Family medicine Dietary Supplements Quality-Adjusted Life Years Health Expenditures business Research Article |
| Zdroj: | Medicine |
| ISSN: | 1536-5964 |
| Popis: | The aim of this study is to assess the cost-effectiveness of a holistic, comprehensive human immunodeficiency virus (HIV) treatment Program in Malawi. Comprehensive cost data for the year 2010 have been collected at 30 facilities from the public network of health centers providing antiretroviral treatment (ART) throughout the country; two of these facilities were operated by the Disease Relief through Excellent and Advanced Means (DREAM) program. The outcomes analysis was carried out over five years comparing two cohorts of patients on treatment: 1) 2387 patients who started ART in the two DREAM centers during 2008, 2) patients who started ART in Malawi in the same year under the Ministry of Health program. Assuming the 2010 cost as constant over the five years the cost-effective analysis was undertaken from a health sector and national perspective; a sensitivity analysis included two hypothesis of ART impact on patients’ income. The total cost per patient per year (PPPY) was $314.5 for the DREAM protocol and $188.8 for the other Malawi ART sites, with 737 disability adjusted life years (DALY) saved among the DREAM program patients compared with the others. The Incremental Cost-Effectiveness Ratio was $1640 per DALY saved; it ranged between $896–1268 for national and health sector perspective respectively. The cost per DALY saved remained under $2154 that is the AFR-E-WHO regional gross domestic product per capita threshold for a program to be considered very cost-effective. HIV/acquired immune deficiency syndrome comprehensive treatment program that joins ART with laboratory monitoring, treatment adherence reinforcing and Malnutrition control can be very cost-effective in the sub-Saharan African setting. |
| Databáze: | OpenAIRE |
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