Fritz Jenna, Wachira Juddy, Wilson-Barthes Marta, Kafu Catherine, Chemtai Diana, Genberg Becky, Galárraga Omar
Bloomberg School of Public Health Johns Hopkins University, Baltimore, MD, USA.
Department of Behavioral Sciences, Moi University, Eldoret, Kenya.
Value Health Reg Issues. 2025 May 21;49:101129. doi: 10.1016/j.vhri.2025.101129.
Patient-centered interventions can improve care engagement and treatment adherence for people living with HIV (PLWH). Yet, evidence on their cost-effectiveness remains sparse, hindering their prioritization over alternative models. This study estimated the cost-effectiveness of a patient-centered intervention for improving viral suppression among PLWH in western Kenya.
We analyzed the cost-effectiveness of an enhanced patient-centered (EPC) intervention via a randomized pilot trial among 328 PLWH in 2 rural clinics. The EPC arm included clinician-patient continuity, treatment dialogue, and flexible scheduling. The provider-patient communication (PPC) arm provided training on motivational interviewing. The standard of care arm provided patient-specific interventions to promote viral suppression. Costs were aggregated across the 2 clinics and measured from a societal perspective, including patient time, transportation, and medication. The incremental cost per disability-adjusted life year averted was calculated based on patient virologic failure risk, HIV transmissions averted, and life expectancy. Key parameters were varied by ±25% to examine uncertainty in incremental cost-effectiveness ratios.
Compared with standard HIV care, both the EPC intervention and PPC training alone were more cost-effective at various willingness-to-pay thresholds. Providing PPC training alone was the dominant strategy (more effective and less costly) compared with the EPC intervention at $97.72 per HIV infection averted and $4.44 per disability-adjusted life year averted. Both interventions were cost savings when factoring in lifetime HIV treatment cost averted.
Patient-centered care models may be highly cost-effective for improving treatment outcomes among PLWH. These encouraging results warrant further testing in fully powered clinical trials.
以患者为中心的干预措施可提高艾滋病毒感染者（PLWH）的护理参与度和治疗依从性。然而，关于其成本效益的证据仍然稀少，这阻碍了它们相对于其他模式的优先地位。本研究估计了一种以患者为中心的干预措施在肯尼亚西部提高PLWH病毒抑制率的成本效益。
我们通过对2家农村诊所的328名PLWH进行随机试点试验，分析了强化以患者为中心（EPC）干预措施的成本效益。EPC组包括医患连续性、治疗对话和灵活排班。医患沟通（PPC）组提供动机性访谈培训。标准护理组提供针对患者的干预措施以促进病毒抑制。成本在2家诊所进行汇总，并从社会角度进行衡量，包括患者时间、交通和药物。根据患者病毒学失败风险、避免的艾滋病毒传播和预期寿命计算每避免一个伤残调整生命年的增量成本。关键参数上下浮动±25%，以检验增量成本效益比的不确定性。
与标准艾滋病毒护理相比，在不同的支付意愿阈值下，EPC干预措施和单独的PPC培训都更具成本效益。单独提供PPC培训是主导策略（更有效且成本更低），与EPC干预措施相比，每避免一例艾滋病毒感染的成本为97.72美元，每避免一个伤残调整生命年的成本为4.44美元。考虑到避免的终身艾滋病毒治疗成本，两种干预措施都节省了成本。
以患者为中心的护理模式对于改善PLWH的治疗结果可能具有很高的成本效益。这些令人鼓舞的结果值得在充分有力的临床试验中进一步测试。
