Intergrated Management for Prevention and Control and Treatment of HIV/AIDS, Bandung, Indonesia.
Health Policy. 2010 Apr;95(1):69-73. doi: 10.1016/j.healthpol.2009.11.003. Epub 2009 Dec 9.
To assess the cost of hospital-based methadone maintenance treatment (MMT) for injecting drug users (IDUs) in Bandung, Indonesia; to address concerns of financial sustainability at the hospital level and financial accessibility and economic attractiveness at the health care policy level.
In a 1 year observation period in 2006-2007, MMT service delivery costs were estimated on the basis of a micro-costing approach. Patient costs were estimated on the basis of a survey among 48 methadone clients.
A total number of 129 clients attended the MMT clinic, resulting in a total of 16,335 client visits. Total annual societal costs of running the MMT clinic equalled Rp 1130 mln (US$123,672), or Rp 69,206 (US$7.57) per client visit. Of total costs, patient costs established the largest share (65%), followed by that of central government (20%), and the hospital (15%). Present consultation tariffs already cover hospital costs and the patient costs of accessing MMT services constitute almost 70% of their income.
Under current circumstances, MMT services are financially sustainable to the hospital. MMT services are subsidized by the central government, and this is warranted considering the important role of the program in HIV/AIDS among IDUs. Still, the present user fee seems a barrier to utilization, and a higher level of subsidy might be justified to reduce the cost to the patient.
评估印度尼西亚万隆市为注射吸毒者提供的基于医院的美沙酮维持治疗（MMT）的成本；解决医院层面财务可持续性以及医疗政策层面经济可及性和经济吸引力的相关问题。
在 2006-2007 年为期一年的观察期内，采用微观成本法估算 MMT 服务提供的成本。根据对 48 名美沙酮患者的调查，估算了患者的成本。
共有 129 名患者参加了 MMT 诊所，总共进行了 16335 次就诊。运营 MMT 诊所的年度社会总成本为 1.13 亿印尼盾（123672 美元），或每次就诊 69206 印尼盾（7.57 美元）。在总成本中，患者成本占最大份额（65%），其次是中央政府（20%）和医院（15%）。目前的咨询费率已涵盖医院成本，而患者获得 MMT 服务的成本几乎占其收入的 70%。
在目前情况下，MMT 服务对医院而言是可持续的。MMT 服务得到中央政府的补贴，考虑到该项目对 IDU 中艾滋病毒/艾滋病的重要作用，这种补贴是合理的。然而，目前的用户费用似乎对利用率构成了障碍，因此可能有理由提高补贴水平，以降低患者的成本。
