title: Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study.
abstract: BACKGROUND
  It is anticipated that demands on ambulatory HIV services will increase in coming years as a consequence of the increased life expectancy of HIV patients on highly active anti-retroviral therapy (HAART). Accurate cost data are needed to enable evidence based policy decisions be made about new models of service delivery, new technologies and new medications.
  
  
  METHODS
  A micro-costing study was carried out in an HIV outpatient clinic in a single regional centre in the south of Ireland. The costs of individual appointment types were estimated based on staff grade and time. Hospital resources used by HIV patients who attended the ambulatory care service in 2012 were identified and extracted from existing hospital systems. Associations between patient characteristics and costs per patient month, in 2012 euros, were examined using univariate and multivariate analyses.
  
  
  RESULTS
  The average cost of providing ambulatory HIV care was found to be €973 (95% confidence interval €938-€1008) per patient month in 2012. Sensitivity analysis, varying the base-case staff time estimates by 20% and diagnostic testing costs by 60%, estimated the average cost to vary from a low of €927 per patient month to a high of €1019 per patient month. The vast majority of costs were due to the cost of HAART. Women were found to have significantly higher HAART costs per patient month while patients over 50 years of age had significantly lower HAART costs using multivariate analysis.
  
  
  CONCLUSIONS
  This study provides the estimated cost of ambulatory care in a regional HIV centre in Ireland. These data are valuable for planning services at a local level, and the identification of patient factors, such as age and gender, associated with resource use is of interest both nationally and internationally for the long-term planning of HIV care provision.
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Cork, Ireland. aline.brennan@ucc.ie.
authors.forename: Aline
authors.initials: A
authors.lastname: Brennan
authors.affiliation: Cork University Hospital and Mercy University Hospital Cork, Cork, Ireland. arthur.jackson@hse.ie.
authors.forename: Arthur
authors.initials: A
authors.lastname: Jackson
authors.affiliation: School of Medicine, University College Cork and Cork University Hospital, Cork, Ireland. m.horgan@ucc.ie.
authors.forename: Mary
authors.initials: M
authors.lastname: Horgan
authors.affiliation: St James's Hospital, Dublin and Trinity College Dublin, Dublin, Ireland. cbergin@stjames.ie.
authors.forename: Colm J
authors.initials: CJ
authors.lastname: Bergin
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Cork, Ireland. j.browne@ucc.ie.
authors.forename: John P
authors.initials: JP
authors.lastname: Browne
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics*; D000554:Ambulatory Care Facilities / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000628:therapy*; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D055815:Young Adult