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The costs of HIV treatment and care in Ghana
Evelinn Mikkelsen1, Jan A C Hontelez, Justice Nonvignon
1aDepartment for Health Evidence, Radboud University Medical Centre, Institute for Health Sciences, Nijmegen bDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands cHeidelberg Institute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany dDepartment of Health Policy, Planning & Management, School of Public Health, College of Health Sciences eInstitute of Statistical, Social & Economic Research (ISSER), University of Ghana, Accra Ghana.
Insights
HIV treatment costs in Ghana are dynamic, not constant. Costs decrease significantly over time on antiretroviral therapy (ART), highlighting the need for dynamic cost functions in resource allocation for HIV care.
Area of Science:
- Health Economics
- Public Health
- Infectious Disease Research
Background:
- HIV treatment and care costs are critical for resource allocation in sub-Saharan Africa.
- Understanding the dynamics of these costs is essential for effective healthcare planning.
Purpose of the Study:
- To determine cost functions for HIV treatment and care in Ghana.
- To analyze cost variations based on CD4 cell count at treatment initiation and duration on antiretroviral therapy (ART).
Main Methods:
- Utilized longitudinal healthcare utilization data from seven Ghanaian ART clinics.
- Developed linear regression models with random and fixed effects to assess cost drivers.
Main Results:
- Patient costs peaked in the first 6 months on ART and decreased significantly by 70% after 4 years.
- While costs were lowest for patients with higher CD4 counts at initiation, the difference was not statistically significant.
Conclusions:
- Healthcare costs for HIV-infected individuals are dynamic and change over time on ART.
- Derived cost functions are valuable for cost-effectiveness analyses and resource allocation in HIV treatment programs.
Objective:
To determine cost functions that describe the dynamics of costs of HIV treatment and care in Ghana by CD4 cell count at treatment initiation and over time on antiretroviral therapy (ART).
Design:
We used detailed longitudinal healthcare utilization data from clinical health records of HIV-infected patients at seven Ghanaian ART clinics to estimate cost functions of treatment and care by CD4 cell count at treatment initiation and time on ART.
Methods:
We developed two linear regression models; one with individual random effects to determine the relationship between CD4 cell count at ART initiation and costs of treatment and care, and one with individual fixed effects to determine the causal effect of time in care on costs of treatment and care.
Results:
Costs for treatment and care were lowest (-7.9 US$) for patients with CD4 cell counts of at least 350 cells/μl at ART initiation, compared with patients with 50 cells/μl or less at ART initiation, yet the difference was not significant. The per-patient costs peaked during the first 6 months on ART at 112.6 US$, and significantly decreased by 70% after 4 years on treatment.
Conclusion:
Our findings show that an accurate analysis of resource needs of HIV treatment and care should take into account that healthcare costs for HIV-infected people are dynamic rather than constant. The cost functions derived from our study are valuable input for cost-effectiveness analyses and research allocation exercises for HIV treatment in sub-Saharan Africa.
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