Costs of HIV/AIDS outpatient services delivered through Zambian public health facilities.
OBJECTIVE
To present evidence on unit and total costs of outpatient HIV/AIDS services in ZPCT-supported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV/AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) in Zambia.


METHODS
Cost data from 2008 were collected in 12 ZPCT-supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider. All shared costs were distributed to clinic visits using appropriate allocation variables. Estimates of annual costs of HIV/AIDS services were made using ZPCT and Ministry of Health data on numbers of persons receiving services in 2009.


RESULTS
Unit costs of visits were driven by costs of drugs, laboratory tests and clinical labour, while variability in visit costs across facilities was explained mainly by differences in utilization. First-year costs of ART per client ranged from US$278 to US$523 depending on drug regimen and facility type; costs of a complete course of antenatal care (ANC) including PMTCT were approximately US$114. Annual costs of ART provided in ZPCT-supported facilities were estimated at US$14.7-$40.1 million depending on regimen, and annual costs of antenatal care including PMTCT were estimated at US$16 million. In Zambia as a whole, the respective estimates were US$41.0-114.2 million for ART and US$57.7 million for ANC including PMTCT.


CONCLUSIONS
Consistent with the literature, total costs of services were dominated by drugs, laboratory tests and clinical labour. For each visit type, variability across facilities in total costs and cost components suggests that some potential exists to reduce costs through greater harmonization of care protocols and more intensive use of fixed resources. Improving facility-level information on the costs of resources used to produce services should be emphasized as an element of health systems strengthening.
FHI, Durham, NC, USA  FHI/ZPCT, Lusaka, Zambia. jbratt@fhi.org
John H
JH
Bratt
Kwasi
K
Torpey
Mushota
M
Kabaso
Yebo
Y
Gondwe
D000553:Ambulatory Care / Q000191:economics*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D003906:Developing Countries; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000628:therapy / Q000635:transmission; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000191:economics / Q000628:therapy; D011295:Prenatal Care / Q000191:economics; D011634:Public Health / Q000191:economics*; D015024:Zambia