Indian Institute of Public Health, Bhubaneswar, Odisha, India.
Pediatric Centre of Excellence for HIV Care, Department of Pediatrics, LTM Medical College and General Hospital, Sion, Mumbai, India.
PLoS One. 2019 Oct 8;14(10):e0223303. doi: 10.1371/journal.pone.0223303. eCollection 2019.
India has recently introduced telemedicine initiatives to enhance access to specialized care at a low cost for the pediatric HIV patients, who face multiple challenges due to growing disease burden and limited preparedness of the health system to address it. There are limited evidences on the cost-effectiveness of these interventions. This study was undertaken in Maharashtra, a province, located in the western region of the country, to inform policy regarding the effectiveness of this programme. The objective was to estimate the unit cost of ART services for pediatric HIV patients and examine the efficiency in the use of resource and treatment compliance resulting from telemedicine initiatives in pediatric HIV compared to usual ART services.
We selected 6 ART centers (3 from linked centers linked to Pediatric HIV Centre of Excellence (PCoE) and 3 from non-linked centers) randomly from three high, middle and low ART centers, categorized on the basis of case load in each arm. A bottom up costing methodology was adopted to understand the unit cost of services. Loss to follow up and timeliness of the visits were compared between the two arms and were linked to the cost.
The average cost per-visit was INR 1803 in the linked centers and that for the non-linked centers was INR 3412. There has been 5 percentage point improvement in lost to follow-up in the linked centers compared to non-linked centers against a back-drop of a reduction in per-pediatric patient cost of INR 557. The linkage has resulted in increase in timeliness of the visits in linked centers compared to non-linked centers.
The telemedicine linkage led to an increase in the case load leading to a decrease in cost. The evidence on efficiency in the use of resource and improvement in treatment compliance as suggested by this study could be used to scale up this initiative.
印度最近推出了远程医疗计划，以降低成本为儿科艾滋病毒患者提供专业护理，这些患者由于疾病负担不断增加和卫生系统应对能力有限，面临着多重挑战。这些干预措施的成本效益证据有限。本研究在马哈拉施特拉邦进行，该邦位于该国西部，旨在为该计划的有效性提供政策信息。目的是估计儿科艾滋病毒患者抗逆转录病毒治疗服务的单位成本，并检查远程医疗计划对儿科艾滋病毒患者的资源利用效率和治疗依从性的影响。
我们从三个高、中、低 ART 中心中随机选择了 6 个 ART 中心（3 个来自与儿科艾滋病毒卓越中心（PCoE）相连的中心，3 个来自非相连的中心），根据每个臂的病例数进行分类。采用自下而上的成本核算方法了解服务的单位成本。比较了两个组之间的随访损失和就诊及时性，并将其与成本联系起来。
连接中心的每次就诊平均费用为 1803 卢比，而非连接中心的每次就诊费用为 3412 卢比。与儿科患者成本降低 557 卢比相比，连接中心的随访损失减少了 5 个百分点。连接中心的就诊及时性有所提高。
远程医疗连接导致病例数增加，从而降低了成本。本研究提示的资源利用效率提高和治疗依从性改善的证据可用于扩大这一计划。
