Health Strategies International, 555 59th Street, Oakland, CA 94609 USA.
Cost Eff Resour Alloc. 2011 Dec 20;9:18. doi: 10.1186/1478-7547-9-18.
Adherence to antiretroviral medication regimens is essential to good clinical outcomes for HIV-infected patients. Little is known about the costs of case management (CM) designed to improve adherence for patients identified as being at risk for poor adherence in resource-constrained settings. This study analyzed the costs, outputs, unit costs and correlates of unit cost variation for CM services in 14 ART sites in Ethiopia from October 2008 through September 2009.
This study applied standard micro-costing methods to identify the incremental costs of the CM program. We divided total CM-attributable costs by three output measures (patient-quarters of CM services delivered, number of patients served and successful patient exits) to derive three separate indices of unit costs. The relationships between unit costs and two operational factors (scale and service-volume to staff ratios) were quantified through bivariate analyses.
The CM program delivered 4,598 patient-quarters of services, serving 5,056 patients and 1,995 successful exits at a cost of $167,457 over 12 months, or $36 per patient-quarter, $33 per patient served and $84 per successful exit from the CM program. Among the 14 sites, mean costs were $11,961 (sd, $3,965) for the 12-month study period, and $51 (sd, $36) per patient-quarter; $48 (sd, $32) per patient served; and $183 (sd, $157) per successful exit. Unit costs varied inversely with scale (r, -0.70 for cost per patient-quarter versus patient-quarters of service) and with the service-volume to staff ratio (r, -0.68 for cost per patient-quarter versus staff per patient-quarter).
For those receiving CM, the program adds 0.52% to the lifetime cost of ART. These data reflect wide variation in unit costs among the study sites and suggest that high patient volume may be a major determinant of CM program efficiency. The observed variations in unit costs also indicate that there may be opportunities to identify staffing patterns that increase overall program efficiency.
抗逆转录病毒药物治疗方案的依从性对于感染 HIV 的患者获得良好的临床效果至关重要。在资源有限的环境下，为那些依从性差的患者设计的病例管理（Case Management，CM）服务以提高其依从性，目前人们对该服务的成本所知甚少。本研究分析了 2008 年 10 月至 2009 年 9 月埃塞俄比亚 14 个 ART 点的 CM 服务的成本、产出、单位成本以及单位成本变化的相关因素。
本研究采用标准微观成本法来确定 CM 项目的增量成本。我们将 CM 项目的总成本除以三个产出指标（患者接受 CM 服务的季度数、服务的患者人数和成功退出的患者人数），以得出三个不同的单位成本指标。通过双变量分析来量化单位成本与两个操作因素（规模和服务量与员工比例）之间的关系。
CM 项目在 12 个月的时间里提供了 4598 个患者季度的服务，服务了 5056 名患者，有 1995 名患者成功退出，总成本为 167457 美元，每个患者季度的成本为 36 美元，每位患者的服务成本为 33 美元，每位患者成功退出 CM 项目的成本为 84 美元。在 14 个站点中，平均成本为 12 个月研究期间的 11961 美元（标准差为 3965 美元），每个患者季度的成本为 51 美元（标准差为 36 美元）；每位患者的服务成本为 48 美元（标准差为 32 美元）；每位患者成功退出的成本为 183 美元（标准差为 157 美元）。单位成本与规模呈负相关（r=-0.70，患者季度的服务量与服务量），与服务量与员工比例呈负相关（r=-0.68，患者季度的服务量与员工）。
对于接受 CM 的患者来说，该项目增加了抗逆转录病毒治疗总成本的 0.52%。这些数据反映了研究地点之间单位成本的广泛差异，并表明高患者量可能是 CM 项目效率的主要决定因素。观察到的单位成本变化也表明，可能有机会确定增加总体项目效率的人员配备模式。
