1 / 17

Antiretroviral Treatment Costs in Mexico

Antiretroviral Treatment Costs in Mexico. Sergio Bautista, Tania Dmytraczenko, Gilbert Kombe and Stefano Bertozzi. WHO/UNAIDS Workshop on Strategic Information for Anti-Retroviral Therapy Programmes 30 June to 2 July, 2003 Assessment of programme outcomes (economic). Purpose of the Study.

jerusha
Download Presentation

Antiretroviral Treatment Costs in Mexico

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Antiretroviral Treatment Costs in Mexico Sergio Bautista, Tania Dmytraczenko, Gilbert Kombe and Stefano Bertozzi WHO/UNAIDS Workshop on Strategic Information for Anti-Retroviral Therapy Programmes30 June to 2 July, 2003Assessment of programme outcomes (economic)

  2. Purpose of the Study • To document—using a consistent methodology—the Mexican experience in HIV/AIDS treatment in 3 health subsystems • Ministry of Health (SSA) • Mexican Social Security Institutes (IMSS/ISSSTE) • National Institutes of Health (INS)

  3. Specific Objectives of the Study • Identify patterns of HIV/AIDS care and treatment and related costs by type of therapy received • ARV triple therapy or not • To estimate the annual care costs per patient by • Level of care Specialized clinics, secondary and tertiary hospitals • Disease stage CDC classification CD4 • Subsystems SSA, IMSS/ISSSTE, INS • Care setting Inpatient, outpatient

  4. Study Approach: Site selection • 11 health facilities were selected • SSA sites (5) • IMSS/ISSSTE sites (4) • INS sites (2) • Geographic Location • Mexico City (6) • Guadalajara (2) • Cuernavaca (2) • Level of Care • Highly specialized tertiary care facilities (3) • Secondary care facilities (7) • Specialized HIV clinic (1)

  5. Study Approach: Sample size and eligibility • Convenience sample to reflect clinical and treatment criteria of interest: • ARV recipients (75%) • Not on ARVs (15%) • Deceased (10%) • 1062 patients randomly selected, with sample stratification • Patients eligibility criteria • 18 years or older at first consultation • Diagnosed with HIV and confirmed by Western, Elisa or laboratory culture, or symptomatic AIDS • Documented visit at a study site between 1/1/2000- 12/31/2001

  6. Data Collection Instruments • Utilization (patient chart review) • Socio-demographic characteristics • Clinical events including outpatient, inpatient, labs, drugs, surgical procedures and interventions • Unit costs (facility questionnaire) • Existing unit cost data • Facility- or subsystem-specific • Micro-costing of AIDS-specific diagnostic tests and drugs • Recurrent costs (except for AIDS-specific tests)

  7. Data Collection Process • 5 trained teams, each composed of an economist and a MD/nurse • Data were captured retrospectively for a period of 3 years from the date of last consultation in the study period • Accuracy and reliability of data collection was strengthened with real-time data entry in the field and error checking interface

  8. Characteristics of the Sample (n=1062)

  9. Key Finding #1: There has been a progressive and rapid uptake of HAART Distribution of Patients by Type of Therapy

  10. .003 year –1 (n = 319) year 1 (n = 712) year 3 (n = 140) .002 .001 0 0 500 1000 1500 2000 Key finding #2: Patients start treatment in advanced stages, improvement is gradual Distribution of CD4 Count

  11. Key Finding #3: Total costs are substantially higher under HAART Average Annual per Patient Cost of Treatment

  12. Key Finding #4: Lab tests and Outpatient visits are the largest contributors to treatment costs, excluding ARVs Average Annual per Patient Cost of Treatment, Excl. ARVs

  13. Key Finding #5: Treatment costs are higher for patients in advanced stages of illness Avg Annual per Patient Cost of Treatment Excl. ARVs, by CD4 count

  14. Summary • Our findings are consistent with studies done in other countries • ARV comprises >75% of total treatment costs • Outpatient and monitoring costs increase as patients start triple therapy • Unlike Sub-Saharan African countries, hospitalization is not a big factor in Mexico • Costs associated with late initiation of treatment and during last year of life

  15. Policy Recommendations I • Governments should be realistic about resource requirements of starting and scaling-up ARV treatment • Lab capacity • Human resource training • Countries should be prepared for the shift in care and treatment patterns of patients on HAART especially from inpatient to outpatient • Clinicians should clearly understand when to initiate and how to monitor patients on therapy

  16. Policy Recommendations II • Estimating total cost of ARV treatment can significantly help countries plan for scaling-up • Negotiating drug prices • Medium to long-term prospective is needed for a full evaluation of program costs

More Related