Costs of hospital-based methadone maintenance treatment in HIV/AIDS control among injecting drug users in Indonesia.
OBJECTIVE
To assess the cost of hospital-based methadone maintenance treatment (MMT) for injecting drug users (IDUs) in Bandung, Indonesia; to address concerns of financial sustainability at the hospital level and financial accessibility and economic attractiveness at the health care policy level.


METHODS
In a 1 year observation period in 2006-2007, MMT service delivery costs were estimated on the basis of a micro-costing approach. Patient costs were estimated on the basis of a survey among 48 methadone clients.


RESULTS
A total number of 129 clients attended the MMT clinic, resulting in a total of 16,335 client visits. Total annual societal costs of running the MMT clinic equalled Rp 1130 mln (US$123,672), or Rp 69,206 (US$7.57) per client visit. Of total costs, patient costs established the largest share (65%), followed by that of central government (20%), and the hospital (15%). Present consultation tariffs already cover hospital costs and the patient costs of accessing MMT services constitute almost 70% of their income.


CONCLUSIONS
Under current circumstances, MMT services are financially sustainable to the hospital. MMT services are subsidized by the central government, and this is warranted considering the important role of the program in HIV/AIDS among IDUs. Still, the present user fee seems a barrier to utilization, and a higher level of subsidy might be justified to reduce the cost to the patient.
Afriandi
Irvan
I
Intergrated Management for Prevention and Control and Treatment of HIV/AIDS, Bandung, Indonesia.
Siregar
Adiatma Y M
AY
Meheus
Filip
F
Hidayat
Teddy
T
van der Ven
Andre
A
van Crevel
Reinout
R
Baltussen
Rob
R
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology*; D006556:Heroin Dependence / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation*; D017721:Hospital Costs; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D008691:Methadone / Q000191:economics* / Q000627:therapeutic use*; D018803:Models, Economic; D015819:Substance Abuse, Intravenous / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation*
D008691:Methadone