Genesis Analytics, Johannesburg, South Africa.
Avenir Health, Glastonbury, Fountain Hills, AZ, United States of America.
PLoS One. 2020 Jan 27;15(1):e0228135. doi: 10.1371/journal.pone.0228135. eCollection 2020.
The introduction of "Treat All" (TA) has been promoted to increase the effectiveness of HIV/AIDS treatment by having patients initiate antiretroviral therapy at an earlier stage of their illness. The impact of introducing TA on the unit cost of treatment has been less clear. The following study evaluated how costs changed after Namibia's introduction of TA in April 2017. A two-year analysis assessed the costs of antiretroviral therapy (ART) during the 12 months before TA (Phase I-April 1, 2016 to March 31, 2017) and the 12 months following (Phase II-April 1, 2017 to March 31, 2018). The analysis involved interviewing staff at ten facilities throughout Namibia, collecting data on resources utilized in the treatment of ART patients and analyzing how costs changed before and after the introduction of TA. An analysis of treatment costs indicated that the unit cost of treatment declined from USD360 per patient per year in Phase I to USD301 per patient per year in Phase II, a reduction of 16%. This decline in unit costs was driven by 3 factors: 1) shifts in antiretroviral (ARV) regimens that resulted in lower costs for drugs and consumables, 2) negotiated reductions in the cost of viral load tests and 3) declines in personnel costs. It is unlikely that the first two of these factors were significantly influenced by the introduction of TA. It is unclear if TA might have had an influence on personnel costs. The reduction in personnel costs may have either represented a positive development (fewer personnel costs associated with increased numbers of healthier patients and fewer visits required) or alternatively may reflect constraints in Namibia's staffing. Prior to this study, it was expected that the introduction of TA would lead to a significant increase in the number of ART patients. However, there was less than a 4% increase in the number of adult patients at the 10 studied facilities. From a financial point of view, TA did not significantly increase the resources required in the ten sampled facilities, either by raising unit costs or significantly increasing the number of ART patients.
“全面治疗”（Treat All，TA）的引入旨在通过让患者在疾病早期开始接受抗逆转录病毒治疗来提高 HIV/AIDS 治疗的效果。引入 TA 对治疗单位成本的影响尚不清楚。本研究评估了纳米比亚在 2017 年 4 月引入 TA 后成本如何变化。为期两年的分析评估了在 TA 引入前 12 个月（第 I 阶段，2016 年 4 月 1 日至 2017 年 3 月 31 日）和引入后 12 个月（第 II 阶段，2017 年 4 月 1 日至 2018 年 3 月 31 日）抗逆转录病毒治疗（ART）的成本。该分析涉及采访纳米比亚十个设施的工作人员，收集治疗 ART 患者所使用资源的数据，并分析引入 TA 前后成本如何变化。对治疗成本的分析表明，治疗单位成本从第 I 阶段的每位患者每年 360 美元降至第 II 阶段的每位患者每年 301 美元，下降了 16%。单位成本的下降是由以下三个因素驱动的：1）抗逆转录病毒（ARV）方案的转变，导致药品和耗材成本降低；2）病毒载量检测费用的协商降低；3）人员成本下降。这三个因素不太可能受到 TA 引入的显著影响。尚不清楚 TA 是否对人员成本有影响。人员成本的降低可能代表着一种积极的发展（与更多健康患者和更少就诊相关的人员成本降低），或者反映了纳米比亚人员配备方面的限制。在这项研究之前，预计 TA 的引入将导致接受 ART 的患者数量显著增加。然而，在这 10 个研究设施中，成年患者的数量仅增加了不到 4%。从财务角度来看，TA 并没有显著增加这 10 个抽样设施所需的资源，无论是通过提高单位成本还是显著增加接受 ART 的患者数量。
