Table 3.
The monthly health service cost per patient of managing individuals with one, two and three conditions in an integrated one-stop clinic in Tanzania and Uganda. The mean costs and 95% confidence intervals reported are in 2020 US$
| Cost component | HIV only | Diabetes | Hypertension | HIV + diabetes1# | HIV + hypertension2# | Diabetes + hypertension3# | HIV + diabetes + hypertension4 |
|---|---|---|---|---|---|---|---|
| Total monthly cost | $34.21 (32.92, 35.59) | $18.28 (17.52, 19.04) | $18.60 (18.13, 19.08) | $39.11 (33.99, 44.33) | $32.18 (30.35, 34.07) | $22.65 (21.86, 23.43) | $36.38 (31.83, 41.07) |
| Personnel | $7.36 (7.21, 7.52) | $7.34 (7.08, 7.61) | $8.15 (7.99, 8.32) | $6.71 (6.15, 7.26) | $6.62 (6.36, 6.90) | $7.72 (7.49, 7.94) | $6.37 (5.80, 6.95) |
| Medication | $12.21 (11.60, 12.83) | $2.11 (1.82, 2.41) | $3.64 (3.43, 3.86) | $18.54 (15.04, 22.36)a | $14.12 (12.98, 15.30)b | $4.99 (4.53, 5.46)c | $16.98 (13.94, 20.45)d |
| Diagnostics | $9.24 (8.30, 10.35) | $3.64 (3.34, 3.97) | $0.45 (0.32, 0.61) | $9.65 (7.31, 11.99) | $6.81 (6.08, 7.54) | $3.87 (3.49, 4.23) | $9.07 (7.08, 11.08) |
| Overheads | $5.39 (5.16, 5.63) | $5.19 (4.80, 5.59) | $6.36 (6.04, 6.67) | $4.21 (3.61, 4.86) | $4.64 (4.33, 4.95) | $6.07 (5.72, 6.42) | $3.97 (3.39, 4.60) |
| Administration | $3.61 (3.39, 3.82) | $3.69 (3.36, 4.03) | $4.56 (4.27, 4.85) | $2.43 (2.03, 2.95) | $2.78 (2.52, 3.06) | $4.19 (3.89, 4.49) | $2.25 (1.87, 2.73) |
| Equipment and furniture | $0.38 (0.35, 0.41) | $0.34 (0.29, 0.38) | $0.40 (0.36, 0.43) | $0.44 (0.31, 0.56) | $0.39 (0.34, 0.44) | $0.51 (0.46, 0.56) | $0.38 (0.27, 0.50) |
| Rental space | $1.41 (1.37, 1.44) | $1.16 (1.11, 1.22) | $1.40 (1.36, 1.43) | $1.34 (1.16, 1.51) | $1.47 (1.40, 1.53) | $1.37 (1.32, 1.42) | $1.34 (1.16, 1.51) |
aThe mean cost for antiretroviral therapy was $16.92 (95% CI 13.22, 20.84) and that of diabetes drugs was $1.62 (95% CI 0.96, 2.39)
bThe mean cost for antiretroviral therapy was $11.88 (95% CI 10.81, 12.99) and that of hypertension drugs was $2.24 (95% CI 1.91, 2.59)
cThe mean cost of diabetes medication was $1.75 (95% CI 1.44, 2.09) and that of hypertension medication was $3.24 (95% CI 2.95, 3.54)
dThe mean cost for antiretroviral therapy was $13.26 (95% CI 10.62, 16.15), hypertension drugs was $2.53 (95% CI 1.78, 3.35) and that of diabetes drugs was $1.19 (95% CI 0.64, 1.94)
1The cost of managing an individual with HIV and diabetes was − $13.39 (95% CI − 18.69, − 8.02) cheaper than managing two individuals with single conditions of HIV and diabetes, i.e., cost reductions of 25.5% (95% CI 15.4%, 35.5%)
2The cost of managing an individual with HIV and hypertension was − $20.63 (95% CI − 23.00, − 18.31) cheaper than managing two individuals with single conditions of HIV and hypertension, i.e., cost reductions of 39.1% (95% CI 35.1%, 42.9%)
3The cost of managing an individual with diabetes and hypertension was − $14.24 (95% CI − 15.42, − 13.05) cheaper than managing two individuals with single conditions of diabetes and hypertension, i.e., cost reduction of 38.6% (95% CI 36.0%, 41.1%)
4The cost of managing an individual with three conditions HIV, diabetes and hypertension is − $34.72 (95% CI − 39.53, − 29.75) cheaper than the cost of managing three individuals with single conditions of HIV, diabetes and hypertension, i.e., cost reductions of 48.8% (95% CI 42.1%, 55.3%). The overall cost of managing individuals with multi-morbidity (2 or 3 conditions) is − $20.74 (95% CI − 37.94, − 9.83) cheaper than the cost of two or more individuals with single conditions, i.e., cost reductions of 38.0% (95% CI 18.8%, 53.1%)
#The average additional cost per month of managing: (i) diabetes in an HIV-infected individual is $4.89 (95% CI − 0.36, 10.22), (ii) hypertension in HIV-infected individual is − $2.03 (95% CI − 4.33, 0.27) and (iii) hypertension in diabetic individuals is $4.37 (95% CI 3.27, 5.49)