The costs of HIV/AIDS care at government hospitals in Zimbabwe

Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
Health Policy and Planning (Impact Factor: 3.47). 01/2001; 15(4):432-40. DOI: 10.1093/heapol/15.4.432
Source: PubMed


According to official figures, HIV infection in Zimbabwe stood at 700 000-1 000 000 in 1995, representing 7-10% of the population, with even higher expected numbers in 2000. Such high numbers will have far reaching effects on the economy and the health care sector. Information on costs of treatment and care of HIV/AIDS patients in health facilities is necessary in order to have an idea of the likely costs of the increasing number of HIV/AIDS patients. Therefore, the present study estimated the costs per in-patient day as well as per in-patient stay for patients in government health facilities in Zimbabwe with special emphasis on HIV/AIDS patients. Data collection and costing was done in seven hospitals representing various levels of the referral system. The costs per in-patient day and per in-patient stay were estimated through a combination of two methods: bottom-up costing methodology (through an in-patient note review) to identify the direct treatment and diagnostic costs such as medication, laboratory tests and X-rays, and the standard step-down costing methodology to capture all the remaining resources used such as hospital administration, meals, housekeeping, laundry, etc. The findings of the study indicate that hospital care for HIV/AIDS patients was considerably higher than for non-HIV/AIDS patients. In five of the seven hospitals visited, the average costs of an in-patient stay for an HIV/AIDS patient were found to be as much as twice as high as a non-HIV/AIDS patient. This difference could be attributed to higher direct costs per in-patient day (medication, laboratory tests and X-rays) as well as longer average lengths of stay in hospital for HIV/AIDS patients compared with non-infected patients. Therefore, the impact on hospital services of increasing number of HIV/AIDS patients will be enormous.

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Available from: Kristian Schultz Hansen, Oct 09, 2014
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    • "Then, the derived cost estimates were used as input parameters in the treatment model to calculate national treatment costs for the year 2006 by multiplying them with assumed numbers of patients ⁄ clients in that year. Unit costs were estimated from existing Rwandan studies (Kagubare et al. 2005; Vinard et al. 2005), international literature (Kombe & Smith 2003; Chandler & Musau 2004; Sweat et al. 2004; Hausler et al. 2006; Nombela et al. 2006; Creese et al. 2002; El-Sony 2006; Guinness et al. 2002; Hansen et al. 2000) and data made available through donors (in particular, the ''Médecins sans Frontière'' (MSF) mid-year planning budget for the year 2005 and service utilisation statistics) and institutions [e.g. Treatment and Research AIDS Centre (TRAC) statistics]. "
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    ABSTRACT: To estimate recurrent costs per patient and costs for a national HIV/AIDS treatment programme model in Rwanda. A national HIV/AIDS treatment programme model was developed. Unit costs were estimated so as to reflect necessary service consumption of people living with HIV/AIDS (PLWHA). Two scenarios were calculated: (1) for patients/clients in the year 2006 and (2) for potential increases of patients/clients. A sensitivity analysis was conducted to test the robustness of results. Average yearly treatment costs were estimated to amount to 504 US$ per patient on antiretroviral therapy (ART) and to 91 US$ for non-ART patients. Costs for the Rwandan HIV/AIDS treatment programme were estimated to lie between 20.9 and 27.1 million US$ depending on the scenario. ART required 9.6 to 11.1 million US$ or 41-46% of national programme costs. Treatment for opportunistic infections and other pathologies consumed 7.1 to 9.3 million US$ or 34% of total costs. Health Care in general and ART more specifically is unaffordable for the vast majority of Rwandan PLWHA. Adequate resources need to be provided not only for ART but also to assure treatment of opportunistic infections and other pathologies. While risk-pooling may play a limited role in the national response to HIV/AIDS, considering the general level of poverty of the Rwandan population, no appreciable alternative to continued donor funding exists for the foreseeable future.
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    • "Thirdly, the cost-effectiveness figures estimated also confirmed the findings of other studies (e.g. [54,55]) namely that for the same disease, it was more attractive from an efficiency point of view to have the health problem taken care of at the lowest level of the referral system as possible. Comparing the cost-effectiveness ratios for the same health problem, the highest ratios were generally found in provincial hospitals followed by district level hospitals and outpatient care. "
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    • "The main demerit of micro-costing is that it requires intensive research. Frequently, micro-costing is used in combination with macro-costing in a single analysis (Hanson et al. 2000; Hongoro 2001). Macro-costing methods generate cost structures or unit costs that are based on aggregate cost patterns, which might incorporate production inefficiencies . "
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