title: Costing analysis of national HIV treatment and care program in Vietnam.
abstract: BACKGROUND
  Vietnam achieved rapid scale-up of antiretroviral therapy (ART), although external funds are declining sharply. To achieve and sustain universal access to HIV services, evidence-based planning is essential. To date, there had been limited HIV treatment and care cost data available in Vietnam.
  
  
  METHODS
  Cost data of outpatient and inpatient HIV care were extracted at 21 sentinel facilities (17 adult and 4 pediatric) that epitomize the national program. Step-down costing for administration costs and bottom-up resource costing for drugs, diagnostics, and labor were used. Records of 1401 adults and 527 pediatric patients were reviewed.
  
  
  RESULTS
  Median outpatient care costs per patient-year for pre-ART, first year ART, later year ART, and second-line ART were US $100, US $316, US $303, and US $1557 for adults; and US $171, US $387, US $320, and US $1069 for children, respectively. Median inpatient care cost per episode was US $162 for adults and US $142 for children. Non-antiretroviral (ARV) costs in adults at stand-alone facilities were 44% (first year ART) and 24% (later year ART) higher than those at integrated facilities. Adults who started ART with CD4 count ≤100 cells per cubic millimeter had 47% higher non-ARV costs in the first year ART than those with CD4 count >100 cells per cubic millimeter. Adult ARV drug costs at government sites were from 66% to 85% higher than those at donor-supported sites in the first year ART.
  
  
  CONCLUSIONS
  The study found that HIV treatment and care costs in Vietnam are economical, yet there is potential to further promote efficiency through strengthening competitive procurement, integrating HIV services, and promoting earlier ART initiation.
authors.affiliation: *Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam; †World Health Organization Vietnam Country Office, Hanoi, Vietnam; ‡Health Policy Unit, Ministry of Health, Hanoi, Vietnam; §Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore; and ‖National Hospital for Tropical Diseases, Hanoi, Vietnam.
authors.forename: Anh Thuy
authors.initials: AT
authors.lastname: Duong
authors.forename: Masaya
authors.initials: M
authors.lastname: Kato
authors.forename: Sarah
authors.initials: S
authors.lastname: Bales
authors.forename: Nhan Thi
authors.initials: NT
authors.lastname: Do
authors.forename: Thu Thi
authors.initials: TT
authors.lastname: Minh Nguyen
authors.forename: Thuy Thi
authors.initials: TT
authors.lastname: Thanh Cao
authors.forename: Long Thanh
authors.initials: LT
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000628:therapy; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D014744:Vietnam / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents