Cost analysis of centralized viral load testing for antiretroviral therapy monitoring in Nicaragua, a low-HIV prevalence, low-resource setting.
BACKGROUND
HIV viral load testing as a component of antiretroviral therapy monitoring is costly. Understanding the full costs and the major sources of inefficiency associated with viral load testing is critical for optimizing the systems and technologies that support the testing process. The objective of our study was to estimate the costs associated with viral load testing performed for antiretroviral therapy monitoring to both patients and the public healthcare system in a low-HIV prevalence, low-resource country.


METHODS
A detailed cost analysis was performed to understand the costs involved in each step of performing a viral load test in Nicaragua, from initial specimen collection to communication of the test results to each patient's healthcare provider. Data were compiled and cross referenced from multiple information sources: laboratory records, regional surveillance centre records, and scheduled interviews with the key healthcare providers responsible for HIV patient care in five regions of the country.


RESULTS
The total average cost of performing a viral load test in Nicaragua varied by region, ranging from US$99.01 to US$124.58, the majority of which was at the laboratory level: $88.73 to $97.15 per specimen, depending on batch size. The average cost to clinics at which specimens were collected ranged from $3.31 to $20.92, depending on the region. The average cost per patient for transportation, food, lodging and lost income ranged from $3.70 to $14.93.


CONCLUSIONS
The quantitative viral load test remains the single most expensive component of the process. For the patient, the distance of his or her residence from the specimen collection site is a large determinant of cost. Importantly, the efficiency of results reporting has a large impact on the cost per result delivered to the clinician and utility of the result for patient monitoring. Detailed cost analysis can identify opportunities for removing barriers to effective antiretroviral therapy monitoring programmes in limited-resource countries with low HIV prevalence.
Programs for Appropriate Technologies in Health (PATH), Seattle, Washington 98121, USA.
Jay
J
Gerlach
PATH, Managua, Nicaragua.
Magda
M
Sequeira
PATH, Managua, Nicaragua.
Vivian
V
Alvarado
Centro Nacional de Diagnóstico y Referencia, Costado Oeste Colonia Primero de Mayo, Managua, Nicaragua.
Christian
C
Cerpas
Centro Nacional de Diagnóstico y Referencia, Costado Oeste Colonia Primero de Mayo, Managua, Nicaragua.
Angel
A
Balmaseda
Centro Nacional de Diagnóstico y Referencia, Costado Oeste Colonia Primero de Mayo, Managua, Nicaragua.
Alcides
A
Gonzalez
Programs for Appropriate Technologies in Health (PATH), Seattle, Washington 98121, USA.
Tala
T
de Los Santos
Programs for Appropriate Technologies in Health (PATH), Seattle, Washington 98121, USA.
Carol E
CE
Levin
PATH, Managua, Nicaragua.
Juan Jose
JJ
Amador
Programs for Appropriate Technologies in Health (PATH), Seattle, Washington 98121, USA.
Gonzalo J
GJ
Domingo
D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D016903:Drug Monitoring / Q000191:economics*; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000821:virology; D006295:Health Resources / Q000191:economics*; D006801:Humans; D007753:Laboratories / Q000191:economics; D009527:Nicaragua / Q000453:epidemiology; D015995:Prevalence; D019562:Viral Load / Q000191:economics*
D019380:Anti-HIV Agents