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- Publisher Website: 10.7326/0003-4819-152-1-201001050-00006
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Article: Association of antiretroviral therapy adherence and health care costs
Title | Association of antiretroviral therapy adherence and health care costs |
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Authors | |
Issue Date | 2010 |
Citation | Annals of Internal Medicine, 2010, v. 152, n. 1, p. 18-25 How to Cite? |
Abstract | Background: Antiretroviral therapy (ART) adherence predicts HIV disease progression and survival, but its effect on direct health care costs is unclear. Objective: To determine the effect of ART adherence on direct health care costs among adults in a resource-limited setting. Design: Cohort study. Setting: Aid for AIDS, a private-sector disease management program in South Africa. Patients: 6833 HIV-infected adults who started ART between 6 August 2000 and 30 April 2006. Measurements: Monthly direct health care costs authorized by Aid for AIDS were averaged over all months. Pharmacy claim adherence, expressed as a percentage, was categorized into quartiles, from 1 (lowest) to 4 (highest). Effects of covariates on monthly total costs were assessed with a 2-step model with logit for probability of nonzero costs and a generalized linear model (GLM). Results: Total mean monthly costs were $370 (SD, $644). Mean monthly costs of ART were $32 (SD, $18); hospitalizations, $151 (SD, $436); consultations, $76 (SD, $66); investigations, $37 (SD, $50); and non-ART medications, $53 (SD, $180). Total mean monthly costs ranged from $313 (SD, $598) for quartile 4 to $376 (SD, $657) for quartile 1. Hospitalization costs increased from 29% to 51% of total costs as adherence decreased. In the GLM 2-step model, moving from adherence quartile 1 to quartile 2, 3, or 4 increased the probability of having nonzero total monthly costs by 0.078, 0.15, and 0.21 percentage point, respectively (P < 0.001). For patients with nonzero costs, increasing adherence from quartile 1 to quartile 2, 3, or 4 decreased total monthly costs by $70, $133, and $192, respectively (P < 0.001). Moving from adherence quartiles 1 to 4 had the highest decrease in net overall median monthly health care costs (-$85 [interquartile range, -$116 to -$41]). Limitations: Indirect health care costs were not included. Experience may not reflect that of public HIV/AIDS programs. Conclusion: High ART adherence was associated with lower mean monthly direct health care costs, particularly reduced hospitalization costs, in this South African HIV cohort. © 2010 American College of Physicians. |
Persistent Identifier | http://hdl.handle.net/10722/326796 |
ISSN | 2021 Impact Factor: 51.598 2020 SCImago Journal Rankings: 3.839 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Nachega, Jean B. | - |
dc.contributor.author | Leisegang, Rory | - |
dc.contributor.author | Bishai, David | - |
dc.contributor.author | Nguyen, Hoang | - |
dc.contributor.author | Hislop, Michael | - |
dc.contributor.author | Cleary, Susan | - |
dc.contributor.author | Regensberg, Leon | - |
dc.contributor.author | Maartens, Gary | - |
dc.date.accessioned | 2023-03-31T05:26:34Z | - |
dc.date.available | 2023-03-31T05:26:34Z | - |
dc.date.issued | 2010 | - |
dc.identifier.citation | Annals of Internal Medicine, 2010, v. 152, n. 1, p. 18-25 | - |
dc.identifier.issn | 0003-4819 | - |
dc.identifier.uri | http://hdl.handle.net/10722/326796 | - |
dc.description.abstract | Background: Antiretroviral therapy (ART) adherence predicts HIV disease progression and survival, but its effect on direct health care costs is unclear. Objective: To determine the effect of ART adherence on direct health care costs among adults in a resource-limited setting. Design: Cohort study. Setting: Aid for AIDS, a private-sector disease management program in South Africa. Patients: 6833 HIV-infected adults who started ART between 6 August 2000 and 30 April 2006. Measurements: Monthly direct health care costs authorized by Aid for AIDS were averaged over all months. Pharmacy claim adherence, expressed as a percentage, was categorized into quartiles, from 1 (lowest) to 4 (highest). Effects of covariates on monthly total costs were assessed with a 2-step model with logit for probability of nonzero costs and a generalized linear model (GLM). Results: Total mean monthly costs were $370 (SD, $644). Mean monthly costs of ART were $32 (SD, $18); hospitalizations, $151 (SD, $436); consultations, $76 (SD, $66); investigations, $37 (SD, $50); and non-ART medications, $53 (SD, $180). Total mean monthly costs ranged from $313 (SD, $598) for quartile 4 to $376 (SD, $657) for quartile 1. Hospitalization costs increased from 29% to 51% of total costs as adherence decreased. In the GLM 2-step model, moving from adherence quartile 1 to quartile 2, 3, or 4 increased the probability of having nonzero total monthly costs by 0.078, 0.15, and 0.21 percentage point, respectively (P < 0.001). For patients with nonzero costs, increasing adherence from quartile 1 to quartile 2, 3, or 4 decreased total monthly costs by $70, $133, and $192, respectively (P < 0.001). Moving from adherence quartiles 1 to 4 had the highest decrease in net overall median monthly health care costs (-$85 [interquartile range, -$116 to -$41]). Limitations: Indirect health care costs were not included. Experience may not reflect that of public HIV/AIDS programs. Conclusion: High ART adherence was associated with lower mean monthly direct health care costs, particularly reduced hospitalization costs, in this South African HIV cohort. © 2010 American College of Physicians. | - |
dc.language | eng | - |
dc.relation.ispartof | Annals of Internal Medicine | - |
dc.title | Association of antiretroviral therapy adherence and health care costs | - |
dc.type | Article | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.7326/0003-4819-152-1-201001050-00006 | - |
dc.identifier.scopus | eid_2-s2.0-74849120025 | - |
dc.identifier.volume | 152 | - |
dc.identifier.issue | 1 | - |
dc.identifier.spage | 18 | - |
dc.identifier.epage | 25 | - |
dc.identifier.eissn | 1539-3704 | - |
dc.identifier.isi | WOS:000273556600003 | - |