title: Cost effectiveness of a pharmacy-only refill program in a large urban HIV/AIDS clinic in Uganda.
abstract: BACKGROUND
  HIV/AIDS clinics in Uganda and other low-income countries face increasing numbers of patients and workforce shortages. We performed a cost-effectiveness analysis comparing a Pharmacy-only Refill Program (PRP), a form of task-shifting, to the Standard of Care (SOC) at a large HIV/AIDS clinic in Uganda, the Infectious Diseases Institute (IDI). The PRP was started to reduce workforce shortages and optimize patient care by substituting pharmacy visits for SOC involving monthly physician visits for accessing antiretroviral medicines.
  
  
  RESULTS
  We used a retrospective cohort analysis to compare the effectiveness of the PRP compared to SOC. Effectiveness was defined as Favorable Immune Response (FIR), measured as having a CD4 lymphocyte count of over 500 cells/µl at follow-up. We used multivariate logistic regression to assess the difference in FIR between patients in the PRP and SOC. We incorporated estimates of effectiveness into an incremental cost-effectiveness analysis performed from a limited societal perspective. We estimated costs from previous studies at IDI and conducted univariate and probabilistic sensitivity analyses. We identified 829 patients, 578 in the PRP and 251 in SOC. After 12.8 months (PRP) and 15.1 months (SOC) of follow-up, 18.9% of patients had a FIR, 18.6% in the PRP and 19.6% in SOC. There was a non-significant 9% decrease in the odds of having a FIR for PRP compared to SOC after adjusting for other variables (OR 0.93, 95% CI 0.55-1.58). The PRP was less costly than the SOC (US$ 520 vs. 655 annually, respectively). The incremental cost-effectiveness ratio comparing PRP to SOC was US$ 13,500 per FIR. PRP remained cost-effective at univariate and probabilistic sensitivity analysis.
  
  
  CONCLUSIONS
  The PRP is more cost-effective than the standard of care. Similar task-shifting programs might help large HIV/AIDS clinics in Uganda and other low-income countries to cope with increasing numbers of patients seeking care.
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, Washington, United States of America. babijo@uw.edu
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Babigumira
authors.forename: Barbara
authors.initials: B
authors.lastname: Castelnuovo
authors.forename: Andy
authors.initials: A
authors.lastname: Stergachis
authors.forename: Agnes
authors.initials: A
authors.lastname: Kiragga
authors.forename: Petra
authors.initials: P
authors.lastname: Shaefer
authors.forename: Mohammed
authors.initials: M
authors.lastname: Lamorde
authors.forename: Andrew
authors.initials: A
authors.lastname: Kambugu
authors.forename: Alice
authors.initials: A
authors.lastname: Muwanga
authors.forename: Louis P
authors.initials: LP
authors.lastname: Garrison
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000191:economics* / Q000276:immunology; D000328:Adult; D018791:CD4 Lymphocyte Count / Q000191:economics; D002947:Cities; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D010604:Pharmacy; D055553:Prescription Drugs / Q000191:economics*; D059039:Standard of Care; D014454:Uganda
chemical_list: D055553:Prescription Drugs