Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Taking ART to Scale: Determinants of the Cost and Cost-Effectiveness of Antiretroviral Therapy in 45 Clinical Sites in Zambia
PLoS ONE, Volume 7, No. 12, Article e51993, Year 2012
Notification
URL copied to clipboard!
Description
Background: We estimated the unit costs and cost-effectiveness of a government ART program in 45 sites in Zambia supported by the Centre for Infectious Disease Research Zambia (CIDRZ). Methods: We estimated per person-year costs at the facility level, and support costs incurred above the facility level and used multiple regression to estimate variation in these costs. To estimate ART effectiveness, we compared mortality in this Zambian population to that of a cohort of rural Ugandan HIV patients receiving co-trimoxazole (CTX) prophylaxis. We used micro-costing techniques to estimate incremental unit costs, and calculated cost-effectiveness ratios with a computer model which projected results to 10 years. Results: The program cost $69.7 million for 125,436 person-years of ART, or $556 per ART-year. Compared to CTX prophylaxis alone, the program averted 33.3 deaths or 244.5 disability adjusted life-years (DALYs) per 100 person-years of ART. In the base-case analysis, the net cost per DALY averted was $833 compared to CTX alone. More than two-thirds of the variation in average incremental total and on-site cost per patient-year of treatment is explained by eight determinants, including the complexity of the patient-case load, the degree of adherence among the patients, and institutional characteristics including, experience, scale, scope, setting and sector. Conclusions and Significance: The 45 sites exhibited substantial variation in unit costs and cost-effectiveness and are in the mid-range of cost-effectiveness when compared to other ART programs studied in southern Africa. Early treatment initiation, large scale, and hospital setting, are associated with statistically significantly lower costs, while others (rural location, private sector) are associated with shifting cost from on- to off-site. This study shows that ART programs can be significantly less costly or more cost-effective when they exploit economies of scale and scope, and initiate patients at higher CD4 counts. © 2012 Marseille et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3527397/bin/pone.0051993.s001.docx
Authors & Co-Authors
Marseille, Elliot A.
United States, Oakland
Health Strategies International
Giganti, Mark Joseph
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Mwango, Albert J.
Zambia, Lusaka
Zambian Ministry of Health
Taylor, Angela
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Mulenga, Lloyd Berdad
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Over, Mead
United States, Washington, D.c.
Center for Global Development
Kahn, James G.
United States, Oakland
Super Models for Global Health
United States, San Francisco
University of California, San Francisco
Stringer, Jeffrey S.A.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Statistics
Citations: 52
Authors: 8
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pone.0051993
e-ISSN:
19326203
Research Areas
Disability
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Zambia