Cost-effective analysis of highly active anti-retroviral treatment (HAART) at Choma General Hospital Art Center in Choma District
Shonga, Chiwambo Rhoza
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The study was conducted in order to estimate the costs and effects of ARVs used in treatment of HIV infected patients, to describe the costs of prophylaxis and treating of opportunistic infections by use of No-ARVs and to determine the incremental cost-effectiveness ratio of No-ART and ART. A cost-effectiveness analysis was conducted from a public health perspective, comparing No- ART with ART intervention. This was a retrospective study done on a cohort of 207 using a pre-ART and ART study design on a five year period observation time (2004 – 2008). The cohort was aged 15 years and above with HIV infection disability and were selected by simple random technique of their records’ files. By the year 2006, with the adult HIV/AIDS prevalence rate of 16% in Zambia, Choma district had a high incidence rate of sexually transmitted infection (STIs) of 15.0 per 1000 population. The HIV infection was at incidence rate of 7.1 per 1000 population and case fatality rate of 195.1 per 1000 admissions and this revealed the high demand of antiretroviral drugs (ARVs) (Choma HMIS, 2006).The cohort simulation approach used was based on cost-effectiveness Markov Modeling in order to calculate life time costs, life years gained and health effects of ART versus No-ART. The study setting was in a public sector health facility at Choma ART centre. Data was collected using file check list, semi-structured interview schedule and discussion with the key informants who had more than five years experience of managing patients with HIV infections at Choma general hospital. Data analysis was done using Cost Model template (WHO CostIt Model) and Excel spread-sheet. The study results revealed that the transition probabilities of patients moving from stage 1 – 4 in No-ART was 0.24917 and in ART it was 0.1239. Transition probabilities of moving from 1 to death in No-ART was higher, 0.0678 and in ART it was only 0.0125. In both ART and No-ART cohort, the health status rating patients in stage 1 had a high utility rating of 0.85. In stage 4 the utility rating was 0.28. The lifetime costs of No-ART were $10,166,199 and for ART, $12,226,813. The costs per life year gained with No-ART were $1,166 and ART were $1,223. The health effects quality-adjusted life years (QALYs) for No-ART were 3,381 and ART, 6.073. The incremental cost-effectiveness ratio was $765.45. The life years lived with No-ART were 3.25 and with ART were 8.50. In conclusion, HAART intervention is reasonably cost-effective for HIV-infected patients in Zambia because the intervention reduces the costs of medical care of HIV disease and the incidences of opportunistic infections. This leads to a corresponding reduction in in-patient health care utilization. Results of cost-effectiveness analysis in this study could assist in enhancing efficient resource allocation and equitable access to HIV treatment.