Izvorni znanstveni članak
https://doi.org/10.3325/cmj.2021.62.54 2
The cost of care for people living with stable HIV in Croatia and the efficiency of EmERGE
Eduard Beck
; NPMS-HHC Community Interest Company, London, United Kingdom
Sundhiya Mandalia
; NPMS-HHC Community Interest Company, London, United Kingdom
Platonas Yfantopoulos
; NPMS-HHC Community Interest Company, London, United Kingdom
Christopher Jones
; Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
Stephen Bremner
; Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
Jennifer Whetham
; Lawson Unit, Brighton and Sussex University Hospitals Trust and Medical School, Brighton, United Kingdom
Ivana Benković
; HIV Department, University Hospital for Infectious Diseases, Zagreb, Croatia
Šime Zekan
; HIV Department, University Hospital for Infectious Diseases, Zagreb, Croatia
Josip Begovac
; Lawson Unit, Brighton and Sussex University Hospitals Trust and Medical School, Brighton, United Kingdom
Sažetak
Aim To estimate the cost-effectiveness of the EmERGE
Pathway of Care for medically stable people living with HIV
(PLHIV) at the University Hospital for Infectious Diseases
(UHID), Zagreb. The Pathway includes a mobile application
enabling individuals to communicate with their caregivers.
Methods This study involving 293 participants collected
data on the use of HIV outpatient services one year before
and after EmERGE implementation. In departments sup
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porting HIV outpatients, a micro-costing exercise was per
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formed to calculate unit costs. These were combined with
mean use of HIV services per patient year (MPPY) to esti
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mate average annual costs. Primary outcomes were CD4
count, viral load, and secondary outcomes were patient
activation, PAM13; and quality of life, PROQOL-HIV. Infor
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mation on out-of-pocket expenditures was also collected.
Results Outpatient visits decreased by 17%, from 4.0 (95%
CI 3.8-4.3) to 3.3 MPPY (95% CI 3.1-3.5). Tests, including CD4
count, decreased, all contributing to a 33% reduction of
annual costs: 7139 HRK (95% CI 6766-7528) to 4781 HRK
(95% CI 4504-5072). Annual costs including anti-retroviral
drugs (ARVs) decreased by 5%: 43 101 HRK (95% CI 42 728-
43,490) to 40 743 HRK (95% CI 40 466-41,034). ARVs remain
the main cost driver in stable PLHIV. Primary and secondary
outcomes did not change substantially between periods.
Conclusion EmERGE Pathway was a cost-saving interven
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tion associated with changes in management, and a reduc
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tion in outpatient visits, tests, and costs. ARV costs domi
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nated costs. Future efficiencies are possible if EmERGE is
introduced to other PLHIV across the UHID and if ARV pric
-
es are reduced.
Ključne riječi
Hrčak ID:
278804
URI
Datum izdavanja:
23.12.2021.
Posjeta: 420 *