Clinical and financial burdens of secondary level care in a public sector antiretroviral roll-out setting (G. F. Jooste Hospital).
BACKGROUND
Antiretroviral therapy (ART) is being extended across South Africa. While efforts have been made to assess the costs of providing ART via accredited service points, little information is available on its downstream costs, particularly in public secondary level hospitals.


OBJECTIVE
To determine the cost of care for inpatients and outpatients at a dedicated antiretroviral referral unit treating and caring for antiretroviral-related conditions in a South African peri-urban setting; to identify key epidemiological cost drivers; and to examine the associated clinical and outcome data.


METHODS
A prospective costing study on 48 outpatients and 25 inpatients was conducted from a health system perspective. Incremental economic costs and clinical data were collected from primary sources at G. F. Jooste Hospital, Cape Town, over a 1-month period (March 2005).


RESULTS
Incremental cost per outpatient was R1 280, and per inpatient R5 802. Costs were dominated by medical staff costs (62% inpatient and 58% outpatient, respectively). Infections predominated among diagnoses and costs--55% and 67% respectively for inpatients, and 49% and 54% respectively for outpatients. Most inpatients and outpatients were judged by attending physicians to have improved or stabilised as a result of treatment (52% and 59% respectively).


CONCLUSIONS
The costs of providing secondary level care for patients on or immediately preceding ART initiation can be significant and should be included in the government's strategic planning: (i) so that the service can be expanded to meet current and future needs; and (ii) to avoid crowding out other secondary level health services.
Kevany
Sebastian
S
Health Economics Unit, University of Cape Town and Center for AIDS Prevention Studies, University of California, San Francisco, USA. sebastian.kevany@ucsf.edu
Meintjes
Graeme
G
Rebe
Kevin
K
Maartens
Gary
G
Cleary
Susan
S
D000328:Adult; D000553:Ambulatory Care / Q000191:economics*; D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012017:Referral and Consultation / Q000191:economics; D012189:Retrospective Studies; D013019:South Africa; D055815:Young Adult
D044966:Anti-Retroviral Agents