Cost and resource use of patients on antiretroviral therapy in the urban and semiurban public sectors of South Africa.
BACKGROUND
South Africa has the world's largest number of patients on antiretroviral treatment (ART). As coverage expands beyond urban environments, the cost of care is becoming increasingly important.


METHODS
Health care cost data for the first year after initiation were analyzed for cohorts of patients in a semiurban and an urban public sector ART clinic in South Africa. We compared mean cost by CD4 cell count and time on ART between clinics.


RESULTS
Patients in both clinics had comparable CD4 cell counts at initiation and under treatment. In the urban clinic, mean cost per patient-year on ART in 2011 USD was $1040 [95% confidence interval (CI): $800 to $1280], of which outpatient cost was $692 (67%) and inpatient cost was $348 (33%). Fourteen percent of urban patients required inpatient care at a mean length of stay of 9 days and mean cost per hospitalized patient of $1663 (95% CI: $1103 to $2041). In the semiurban clinic, mean cost per patient-year on ART was $1115 (95% CI: $776 to $1453), of which outpatient cost was $697 (63%) and inpatient cost $418 (37%). Seven percent of semiurban patients required inpatient care at a mean length of stay of 28 days and mean cost per hospitalized patient of $3824 (95% CI: $1143 to $6505).


CONCLUSIONS
Outpatient ART provision in the semiurban setting cost the same as in the urban setting, but inpatient costs are higher in the semiurban clinic because of longer hospitalizations. Cost in both clinics was highest in the first 3 months on ART and at CD4 cell counts <50 cells/μL.
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom. gesine@bu.edu
Gesine
G
Meyer-Rath
Alec
A
Miners
Andreia C
AC
Santos
Ebrahim
E
Variava
Willem Daniel Francois
WD
Venter
D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016527:Drug Costs / Q000706:statistics & numerical data; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D013019:South Africa; D019036:Suburban Health Services / Q000191:economics / Q000706:statistics & numerical data; D019037:Urban Health Services / Q000191:economics / Q000592:standards; D014505:Urban Population / Q000706:statistics & numerical data
D019380:Anti-HIV Agents