Cost-Effectiveness of Linkage Case Management for Hospitalized People With HIV

Area of Science:

• Public Health
• Health Economics
• HIV/AIDS Research

Background:

• Case management interventions are crucial for improving HIV care engagement in resource-constrained settings.
• Understanding the economic value of such interventions is vital for minimizing HIV-related morbidity and mortality.

Purpose of the Study:

• To evaluate the cost-effectiveness of the Daraja intervention compared to enhanced standard care.
• Assess costs and health outcomes from both the Tanzanian Ministry of Health and societal perspectives.

Main Methods:

• Prospective economic evaluation alongside a randomized clinical trial in Northwestern Tanzania (March 2019 - March 2023).
• Participants with HIV were randomized to either the Daraja intervention or enhanced standard care.
• Primary outcome measured was cost per disability-adjusted life-year (DALY) averted over 3 and 12 months.

Main Results:

• The Daraja intervention incurred higher costs from both Ministry of Health and societal perspectives at 3 and 12 months.
• However, Daraja was associated with lower disability-adjusted life-years (DALYs) at both time points.
• Specifically, 1.2 DALYs were averted annualized at 3 months and 1.1 DALYs at 12 months.

Conclusions:

• The Daraja intervention is more costly than standard care but leads to improved health outcomes (DALYs averted).
• These findings indicate a high probability that Daraja is cost-effective from both Ministry of Health and societal perspectives.
• The study supports the economic viability of case management interventions for enhancing HIV care engagement.