aDepartment for Health Evidence, Radboud University Medical Centre, Institute for Health Sciences, Nijmegen bDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands cHeidelberg Institute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany dDepartment of Health Policy, Planning & Management, School of Public Health, College of Health Sciences eInstitute of Statistical, Social & Economic Research (ISSER), University of Ghana, Accra Ghana.
AIDS. 2017 Oct 23;31(16):2279-2286. doi: 10.1097/QAD.0000000000001612.
OBJECTIVE: To determine cost functions that describe the dynamics of costs of HIV treatment and care in Ghana by CD4 cell count at treatment initiation and over time on antiretroviral therapy (ART). DESIGN: We used detailed longitudinal healthcare utilization data from clinical health records of HIV-infected patients at seven Ghanaian ART clinics to estimate cost functions of treatment and care by CD4 cell count at treatment initiation and time on ART. METHODS: We developed two linear regression models; one with individual random effects to determine the relationship between CD4 cell count at ART initiation and costs of treatment and care, and one with individual fixed effects to determine the causal effect of time in care on costs of treatment and care. RESULTS: Costs for treatment and care were lowest (-7.9 US$) for patients with CD4 cell counts of at least 350 cells/μl at ART initiation, compared with patients with 50 cells/μl or less at ART initiation, yet the difference was not significant. The per-patient costs peaked during the first 6 months on ART at 112.6 US$, and significantly decreased by 70% after 4 years on treatment. CONCLUSION: Our findings show that an accurate analysis of resource needs of HIV treatment and care should take into account that healthcare costs for HIV-infected people are dynamic rather than constant. The cost functions derived from our study are valuable input for cost-effectiveness analyses and research allocation exercises for HIV treatment in sub-Saharan Africa.
目的：通过治疗起始时的 CD4 细胞计数和抗逆转录病毒治疗 (ART) 期间的时间，确定描述加纳 HIV 治疗和护理成本动态的成本函数。
设计：我们使用来自加纳 7 家 ART 诊所 HIV 感染患者临床健康记录的详细纵向医疗保健利用数据，来估计治疗和护理的成本函数，根据治疗起始时的 CD4 细胞计数和 ART 期间的时间来计算。
方法：我们开发了两个线性回归模型；一个是个体随机效应模型，用于确定治疗起始时的 CD4 细胞计数与治疗和护理成本之间的关系，另一个是个体固定效应模型，用于确定治疗和护理成本随时间变化的因果效应。
结果：与治疗起始时 CD4 细胞计数为 50 个/μl 或更少的患者相比，治疗起始时 CD4 细胞计数至少为 350 个/μl 的患者的治疗和护理费用最低（-7.9 美元），但差异无统计学意义。每位患者的治疗费用在 ART 治疗的前 6 个月达到峰值，为 112.6 美元，在治疗 4 年后显著下降 70%。
结论：我们的研究结果表明，对 HIV 治疗和护理资源需求的准确分析应考虑到 HIV 感染者的医疗保健费用是动态的，而不是恒定的。本研究得出的成本函数对于撒哈拉以南非洲地区 HIV 治疗的成本效益分析和研究资源分配具有重要意义。
AIDS. 2017-10-23
Ann Intern Med. 2009-8-4
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