Table 1.
Unit costs of inputs and resource utilization by treatment arm
| Unit costs of inputs in US $ | Unit cost | ||
|---|---|---|---|
| Antiretroviral therapy | |||
| Cost of first line ART regimen (per patient per month): didanosine, lamivudine, efavirenz | 47.17 | ||
| Laboratory tests (cost per test) | |||
| CD4+ count | 8.51 | ||
| HIV viral load | 40.16 | ||
| Chest radiograph | 11.91 | ||
| Liver function test | 39.41 | ||
| Full blood count | 6.47 | ||
| Urine & Electrolytes | 19.33 | ||
| Visit costs | |||
| Average cost of unscheduled consultation | 23.68 | ||
| Cost per missed visit (cost of tracing)3 | 6.16 | ||
|
Hospitalizations | |||
| Cost per hospital day (level 2 hospital) | 45.65 | ||
| Costs in different arms |
Arm-1 (N=214) |
Arm-2 (N= 215) |
Arm-3 (N=213) |
| Median monthly cost of second line ART (for patients on second-line) | 73.45 | 85.27 | 85.27 |
| Outpatient visit costs 1 | |||
| Average staff cost per ART consultation (clinician) | 20.79 | 20.10 | 20.10 |
| Average staff cost per ART consultation (professional nurse)2 | 16.49 | 16.49 | 16.49 |
| Average staff cost per tuberculosis only consultation (clinician) | 13.93 | 14.01 | 14.01 |
| Total cost of scheduled ART consultations over 18 months | 393.57 | 386.08 | 386.08 |
| Hospitalizations | |||
| Average “other costs” per hospital admission3 | 120.12 | 108.81 | 146.08 |
| Resource utilization | |||
| Number of patients with: | n (%) | n (%) | n (%) |
| More than one missed visit | 29 (13.6%) | 41 (19.1%) | 47 (22.1%) |
| More than one unscheduled consultation in first 3 months of tuberculosis treatment. | 57 (26.6%) | 13 (6.1%) | 4 (1.9%) |
| Switched to second line ART regimen | 10 (4.7%) | 8 (3.7%) | 7 (3.3%) |
| Did not initiate ART | 15 (7.0%) | 52 (24.2%) | 77 (36.1%) |
| Multidrug resistant tuberculosis | 13 (6.1%) | 8 (3.7%) | 9 (4.2%) |
| Immune reconstitution syndrome | 43 (20.1%) | 18 (8.4%) | 20 (9.4%) |
| Serious adverse events | 52 (24.3%) | 43 (20.0%) | 62 (29.1%) |
| Hospitalization | 40 (18.7%) | 30 (14.0%) | 46 (21.6%) |
| More than 5 days hospitalized | 26 (12.2%) | 21 (9.8%) | 36 (16.9%) |
| Total number of | N | N | N |
| Hospital days | 869 | 519 | 1241 |
| Patient months | 3019 | 2836 | 2703 |
| Median (IQR) | Median (IQR) | Median (IQR) | |
| Number of unscheduled consultations | 1 (1–3) | 1 (1–2) | 1 (1–3) |
| Time to ART regimen switch (months) | 8.5 (3.5–10.9) | 11.8 (9.1–12.5) | 8.2 (5.3,9.0) |
| Length of tuberculosis treatment (days) | 204 (196–253) | 202 (194–253) | 198 (182–252) |
| Number of CD4+ count tests | 5 (4 – 6) | 6 (4 – 6) | 5 (3–6) |
| Number of viral load tests | 4.5 (3 – 5) | 5 (3–5) | 4 (2–5) |
| Rate (per 100 person years) | |||
| Rate of hospitalization | 18.2 | 15.5 | 23.0 |
ART: Antiretroviral treatment
All costs in 2009 US dollars
The staff cost includes the cost of all categories of staff that deal directly with the patient (reception, nursing staff, clinicians and counsellors). The cost of a visit is determined by the length of the visit as well as the salary of the type of staff member conducting the consultation.
Professional nurses saw all stable patients for scheduled consultations from the eighth month of ART treatment onwards. Clinicians saw patients at regular scheduled intervals, following CD4+ count and viral load tests.
Includes the cost of transportation to hospital, CAPRISA staff cost of admission and follow-up while in hospital.
Source of safety laboratory test prices: National Health Laboratory Services (2009)