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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.

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Antiretroviral Treatment Costs in Mexico

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  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

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