Providing HIV treatment in Tanzania costs relatively little, but means a large increase in current health spending

The costs of providing antiretroviral therapy services to HIV-infected individuals presenting with advanced HIV disease at public health centres in Dar es Salaam, Tanzania: Findings from a randomised trial evaluating different health care strategies.

Kimaro GD, Mfinanga S, Simms V, Kivuyo S, Bottomley C, Hawkins N, Harrison TS, Jaffar S, Guinness L, on behalf of the REMSTART trial team. PLoS One. 2017 Feb 24;12(2):e0171917. doi: 10.1371/journal.pone.0171917. eCollection 2017.

Background: Understanding the costs associated with health care delivery strategies is essential for planning. There are few data on health service resources used by patients and their associated costs within antiretroviral (ART) programmes in Africa.

Material and methods: The study was nested within a large trial, which evaluated screening for cryptococcal meningitis and tuberculosis and a short initial period of home-based adherence support for patients initiating ART with advanced HIV disease in Tanzania and Zambia. The economic evaluation was done in Tanzania alone. We estimated costs of providing routine ART services from the health service provider's perspective using a micro-costing approach. Incremental costs for the different novel components of service delivery were also estimated. All costs were converted into US dollars (US$) and based on 2012 prices.

Results: Of 870 individuals enrolled in Tanzania, 434 were enrolled in the intervention arm and 436 in the standard care/control arm. Overall, the median (IQR) age and CD4 cell count at enrolment were 38 [31, 44] years and 52 [20, 89] cells/mm3, respectively. The mean per patient costs over the first three months and over a one year period of follow up following ART initiation in the standard care arm were US$ 107 (95%CI 101-112) and US$ 265 (95%CI 254-275) respectively. ART drugs, clinic visits and hospital admission constituted 50%, 19%, and 19% of the total cost per patient year, while diagnostic tests and non-ART drugs (co-trimoxazole) accounted for 10% and 2% of total per patient year costs. The incremental costs of the intervention to the health service over the first three months was US$ 59 (p<0.001; 95%CI 52-67) and over a one year period was US$ 67(p<0.001; 95%CI 50-83). This is equivalent to an increase of 55% (95%CI 51%-59%) in the mean cost of care over the first three months, and 25% (95%CI 20%-30%) increase over one year of follow up.

Abstract [1]  Full-text [free] access  [2]

Editor’s notes: There are very few data on the cost of providing HIV treatment in sub-Saharan Africa. The authors of this paper analysed cost data from a trial of screening services for opportunistic infections, to estimate the additional costs of HIV treatment to the health service. The most costly part of treatment was the antiretroviral medicines themselves, followed by clinic visits and hospital admissions. Diagnostic tests and treatments for other conditions were relatively inexpensive. The overall costs of treatment to the health system were fairly low in absolute terms. At around US$67 per year this is on the cheaper side of many cost studies. However, HIV treatment increases overall health system costs by a quarter. This could have significant implications for health system funding requirements in Tanzania as treatment is offered to the many people who need it in the UNAIDS 90-90-90 treatment target.

Africa [6]
United Republic of Tanzania [7]
  • [8]