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Coste de los servicios de consulta externa para el VIH/SIDA entregados a través de los centros sanitarios públicos de Zambia
Author(s) -
Bratt John H.,
Torpey Kwasi,
Kabaso Mushota,
Gondwe Yebo
Publication year - 2011
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2010.02640.x
Subject(s) - medicine , total cost , christian ministry , unit cost , environmental health , developing country , health care , unit (ring theory) , average cost , public health , regimen , family medicine , business , nursing , economic growth , surgery , philosophy , mathematics education , theology , accounting , mathematics , neoclassical economics , economics , microeconomics
Summary Objective To present evidence on unit and total costs of outpatient HIV/AIDS services in ZPCT‐supported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV/AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother‐to‐child transmission (PMTCT) in Zambia. Methods Cost data from 2008 were collected in 12 ZPCT‐supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider. All shared costs were distributed to clinic visits using appropriate allocation variables. Estimates of annual costs of HIV/AIDS services were made using ZPCT and Ministry of Health data on numbers of persons receiving services in 2009. Results Unit costs of visits were driven by costs of drugs, laboratory tests and clinical labour, while variability in visit costs across facilities was explained mainly by differences in utilization. First‐year costs of ART per client ranged from US$278 to US$523 depending on drug regimen and facility type; costs of a complete course of antenatal care (ANC) including PMTCT were approximately US$114. Annual costs of ART provided in ZPCT‐supported facilities were estimated at US$14.7–$40.1 million depending on regimen, and annual costs of antenatal care including PMTCT were estimated at US$16 million. In Zambia as a whole, the respective estimates were US$41.0–114.2 million for ART and US$57.7 million for ANC including PMTCT. Conclusions Consistent with the literature, total costs of services were dominated by drugs, laboratory tests and clinical labour. For each visit type, variability across facilities in total costs and cost components suggests that some potential exists to reduce costs through greater harmonization of care protocols and more intensive use of fixed resources. Improving facility‐level information on the costs of resources used to produce services should be emphasized as an element of health systems strengthening.