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BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study

Authors: Aline Brennan, Arthur Jackson, Mary Horgan, Colm J Bergin, John P Browne

Published in: BMC Health Services Research | Issue 1/2015

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Abstract

Background

It is anticipated that demands on ambulatory HIV services will increase in coming years as a consequence of the increased life expectancy of HIV patients on highly active anti-retroviral therapy (HAART). Accurate cost data are needed to enable evidence based policy decisions be made about new models of service delivery, new technologies and new medications.

Methods

A micro-costing study was carried out in an HIV outpatient clinic in a single regional centre in the south of Ireland. The costs of individual appointment types were estimated based on staff grade and time. Hospital resources used by HIV patients who attended the ambulatory care service in 2012 were identified and extracted from existing hospital systems. Associations between patient characteristics and costs per patient month, in 2012 euros, were examined using univariate and multivariate analyses.

Results

The average cost of providing ambulatory HIV care was found to be €973 (95% confidence interval €938 - €1008) per patient month in 2012. Sensitivity analysis, varying the base-case staff time estimates by 20% and diagnostic testing costs by 60%, estimated the average cost to vary from a low of €927 per patient month to a high of €1019 per patient month. The vast majority of costs were due to the cost of HAART. Women were found to have significantly higher HAART costs per patient month while patients over 50 years of age had significantly lower HAART costs using multivariate analysis.

Conclusions

This study provides the estimated cost of ambulatory care in a regional HIV centre in Ireland. These data are valuable for planning services at a local level, and the identification of patient factors, such as age and gender, associated with resource use is of interest both nationally and internationally for the long-term planning of HIV care provision.
Literature
1.
2.
van Sighem AI, Gras LJ, Reiss P, Brinkman K, de Wolf F. Life expectancy of recently diagnosed asymptomatic HIV-infected patients approaches that of uninfected individuals. AIDS (London, England). 2010;24:1527–35.CrossRef
3.
Nakagawa F, Lodwick RK, Smith CJ, Smith R, Cambiano V, Lundgren JD, et al. Projected life expectancy of people with HIV according to timing of diagnosis. AIDS (London, England). 2012;26:335–43.CrossRef
4.
High KP, Brennan-Ing M, Clifford DB, Cohen MH, Currier J, Deeks SG, et al. HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH office of AIDS research by the HIV and aging working group. J Acquir Immune Defic Syndr. 2012;60:S1–18.CrossRefPubMed
5.
HIV and ageing - a special supplement to the UNAIDS report on the global AIDS epidemic 2013. Geneva: UNAIDS; 2013.
6.
HIV in Ireland 2012 Report. Dublin: Health Protection Surveillance Centre; 2013.
7.
Tuite H, Horgan M, Mallon P, McConkey S, Mooka B, Mulcahy F, et al. Antiretroviral treatment and viral load responses in HIV-infected patients accessing specialist care in Ireland. London: 22nd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID); 2012.
8.
Blair JM, Fagan JL, Frazier EL, Do A, Bradley H, Valverde EE, et al. Behavioral and clinical characteristics of persons receiving medical care for HIV infection - medical monitoring project, United States, 2009. Morb Mortal Wkly Rep Surveill Summ (Washington, DC : 2002). 2014;63 Suppl 5:1–22.
9.
HIV in the United Kingdom: 2012 Report. London: Health Protection Agency; 2012.
10.
Ambrosioni J, Nicolas D, Aguero F, Manzardo C, Miro JM. HIV treatment outcomes in Europe and North America: what can we learn from the differences? Expert Rev Anti Infect Ther. 2014;12(5):523–6.CrossRefPubMed
11.
Beck EJ, Avila C, Gerbase S, Harling G, De Lay P. Counting the cost of not costing HIV health facilities accurately pay now, or pay more later. Pharmacoecon. 2012;30(10):887–902.CrossRef
12.
Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of healthcare programmes. 3rd ed. Oxford: Oxford University Press; 2005.
13.
Tan SS, Rutten FF, van Ineveld BM, Redekop WK, Hakkaart-van Roijen L. Comparing methodologies for the cost estimation of hospital services. Eur J Health Econ. 2009;10(1):39–45.CrossRefPubMed
14.
Wordsworth S, Ludbrook A, Caskey F, Macleod A. Collecting unit cost data in multicentre studies. Creating comparable methods. Eur J Health Econ. 2005;6(1):38–44.CrossRefPubMed
15.
Heerey A, McGowan B, Ryan M, Barry M. Microcosting versus DRGs in the provision of cost estimates for use in pharmacoeconomic evaluation. Expert Rev Pharmacoecon Outcomes Res. 2002;2:29–33.CrossRefPubMed
16.
Ryan M. A study of the impact of highly active antiretroviral therapy on the pharmacoepidemiology and pharmacoeconomics of HIV infection. Dublin: University of Dublin, Trinity College; 2000.
17.
18.
Department of Health and Children. Money Follows the Patient – Policy Paper on Hospital Financing. 2013.
19.
Williams I, Churchill D, Anderson J, Boffito M, Bower M, Cairns G, et al. British HIV association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2012. HIV Med. 2012;13 Suppl 2:1–85.
20.
European AIDS Clinical Society Guidelines Version 6.0 October 2011. Brussels: European AIDS Clinical Society; 2011.
21.
22.
23.
24.
25.
Mihaylova B, Briggs A, O’Hagan A, Thompson SG. Review of statistical methods for analysing healthcare resources and costs. Health Econ. 2011;20(8):897–916.CrossRefPubMed
26.
Glick HA, Doshi JA, Sonnad SA, Polsky D. Economic evaluation in clinical trials. 2nd ed. Oxford: Oxford University Press; 2015.
27.
Ghatnekar O, Hjortsberg C, Gisslén M, Lindbäck S, Löthgren M. Medical resource utilization and cost of HIV-related care in the highly active antiretroviral therapy era at a University Clinic in Sweden. Pharmacoecon. 2010;28 Suppl 1:49–57.CrossRef
28.
Mostardt S, Hanhoff N, Wasem J, Goetzenich A, Schewe K, Wolf E, et al. Cost of HIV and determinants of health care costs in HIV-positive patients in Germany: results of the DAGNA K3A study. Eur J Health Econ. 2013;14(5):799–808.CrossRefPubMed
29.
Lopez-Bastida J, Oliva-Moreno J, Perestelo-Perez L, Serrano-Aguilar P. The economic costs and health-related quality of life of people with HIV/AIDS in the Canary Islands, Spain. BMC Health Serv Res. 2009;9:55.CrossRefPubMedPubMedCentral
30.
Beck EJ, Mandalia S, Gaudreault M, Brewer C, Zowall H, Gilmore N, et al. The cost-effectiveness of highly active antiretroviral therapy, Canada 1991–2001. AIDS. 2004;18(18):2411–8.PubMed
31.
Krentz H, Gill M. Increased costs of HIV care associated with aging in an HIV-infected population. HIV Med. 2015;16(1):38–47.CrossRefPubMed
32.
Rizzardini G, Restelli U, Bonfanti P, Porazzi E, Ricci E, Casartelli L, et al. The cost of HIV disease in Northern Italy: the payer’s perspective. J Acquir Immune Defic Syndr. 2011;57(3):211–7.CrossRefPubMed
33.
Gardner EM, Maravi ME, Rietmeijer C, Davidson AJ, Burman WJ. The association of adherence to antiretroviral therapy with healthcare utilization and costs for medical care. Appl Health Econ Health Policy. 2008;6(2–3):145–55.CrossRefPubMedPubMedCentral
34.
Yazdanpanah Y. Costs associated with combination antiretroviral therapy in HIV-infected patients. J Antimicrob Chemother. 2004;53(4):558–61.CrossRefPubMed
35.
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.CrossRefPubMedPubMedCentral
36.
Walensky RP, Sax PE, Nakamura YM, Weinstein MC, Pei PP, Freedberg KA, et al. Economic savings versus health losses: the cost-effectiveness of generic antiretroviral therapy in the United States. Ann Intern Med. 2013;158(2):84–92.CrossRefPubMedPubMedCentral
37.
Gazzard B, Moecklinghoff C, Hill A. New strategies for lowering the costs of antiretroviral treatment and care for people with HIV/AIDS in the United Kingdom. ClinicoEconomics Outcomes Res. 2012;4:193–200.
38.
Hill A, Hill T, Jose S, Pozniak A. Predicted savings to the UK National Health Service from switching to generic antiretrovirals, 2014–2018. J Int AIDS Soc. 2014;17(4 Suppl 3):19497.PubMedPubMedCentral
39.
Brennan A, Morley D, O’Leary AC, Bergin CJ, Horgan M. Determinants of HIV outpatient service utilization: a systematic review. AIDS Behav. 2015;19(1):104–19.CrossRefPubMed
40.
Krentz HB, Gill MJ. The direct medical costs of late presentation (<350/mm) of HIV infection over a 15-year period. AIDS Res Treat. 2012;2012:757135.PubMed
41.
Brennan A, Jackson A, Browne J, Bergin C, Horgan M. Use of hospital services by HIV patients, 2012. Value Health. 2014;17(7):A684.CrossRefPubMed
42.
Gillespie P, O’Neill C, Avalos G, O’Reilly M, Dunne F, Collaborators AD. The cost of universal screening for gestational diabetes mellitus in Ireland. Diabet Med. 2011;28(8):912–8.CrossRefPubMed
Metadata
Title
Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study
Authors
Aline Brennan
Arthur Jackson
Mary Horgan
Colm J Bergin
John P Browne
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0816-1

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