title: A comparative analysis of outpatient costs in HIV treatment programs.
abstract: OBJECTIVE
  To analyze the costs of human immunodeficiency virus (HIV) outpatient treatment for individuals with different CD4 cell counts in the Brazilian public health system, and to compare to costs in other national health systems.
  
  
  METHODS
  A retrospective survey was conducted in five public outpatient clinics of the Brazilian national HIV program in the city of São Paulo. Data on healthcare services provided for a period of one year of HIV outpatient treatment were gathered from randomly selected medical records. Prices of inputs used were obtained through market research and public sector databases. Information on costs of HIV outpatient treatment in other national health systems were gathered from the literature. Annual costs of HIV outpatient treatment from each country were converted into 2010 U.S. dollars.
  
  
  RESULTS
  Annual cost of HIV outpatient treatment for the Brazilian national public program was US$ 2,572.92 in 2006 in São Paulo, ranging from US$ 1,726.19 for patients with CD4 cell count > 500 to US$ 3,693.28 for patients with 51 < CD4 cell count < 200. Antiretrovirals (ARVs) represented approximately 62.0% of annual HIV outpatient costs. Comparing among different health systems during the same period, HIV outpatient treatment presented higher costs in countries where HIV treatment is provided by the private sector.
  
  
  CONCLUSIONS
  The main cost drivers of HIV outpatient treatment in different health systems were: ARVs, other medications, health professional services, and diagnostic exams. Nevertheless, the magnitude of cost drivers varied among HIV outpatient treatment programs due to health system efficiency. The data presented may be a valuable tool for public policy evaluation of HIV treatment programs worldwide.
authors.affiliation: Faculdade de Economia, Administração e Contabilidade da Universidade de São Paulo (FEA-USP), São Paulo, SP, Brazil. flamori@usp.br
authors.forename: Flavia Mori
authors.initials: FM
authors.lastname: Sarti
authors.forename: Marislei
authors.initials: M
authors.lastname: Nishijima
authors.forename: Antonio Carlos Coelho
authors.initials: AC
authors.lastname: Campino
authors.forename: Denise Cavallini
authors.initials: DC
authors.lastname: Cyrillo
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics / Q000276:immunology; D000553:Ambulatory Care / Q000191:economics*; D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D001938:Brazil; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000276:immunology; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D009313:National Health Programs / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D044966:Anti-Retroviral Agents