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Cost Effectiveness of Facility-Based Care, Home-Based Care and Mobile Clinics for Provision of Antiretroviral Therapy in Uganda

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Abstract

Background: Stakeholders in HIV/AIDS care currently use different programmes for provision of antiretroviral therapy (ART) in Uganda. It is not known which of these represents the best value for money.

Objective: To compare the cost effectiveness of home-based care (HBC), facility-based care (FBC) and mobile clinic care (MCC) for provision of ART in Uganda.

Methods: Incremental cost-effectiveness analysis was performed using decision and Markov modeling of adult AIDS patients in WHO Clinical Stage 3 and 4 from the perspective of the Ugandan healthcare system. The main outcome measures were cost (year 2008 values), life expectancy in life-years (LY) and the incremental cost-effectiveness ratio (ICER) measured as cost per QALY or LY gained over 10 years.

Results: Ten-year mean undiscounted life expectancy was lowest for FBC (3.6 LY), followed by MCC (4.3 LY) and highest for HBC (5.3 LY), while the mean discounted QALYs were also lowest for FBC (2.3), followed by MCC (2.9) and highest for HBC (3.7). The 10-year mean costs per patient were lowest for FBC ($US3212), followed by MCC ($US4782) and highest for HBC ($US7033). The ICER was lower for MCC versus FBC ($US2241 per LY and $US2615 per QALY) than for HBC versus MCC ($US2251 per LY and $US2814 per QALY). FBC remained cost effective in univariate and probabilistic sensitivity analyses.

Conclusions: FBC appears to be the most cost-effective programme for provision of ART in Uganda. This analysis supports the implementation of FBC for scale-up and sustainability of ART in Uganda. HBC and MCC would be competitive only if there is increased access, increased adherence or reduced cost.

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Acknowledgements

This project was supported by NIH research grant # D43 TW000011 funded by the Fogarty International Center. The funders had no role in the conduct of the study or preparation of the paper. The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Pharmaceutical Outcomes Research & Policy Program, Department of Pharmacy, University of Washington, Box 357630, Seattle, Washington, 98195-7630, USA

    Joseph B. Babigumira

  2. Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA

    Ajay K. Sethi

  3. Department of Epidemiology & Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA

    Kathleen A. Smyth & Mendel E. Singer

  4. Neurological Outcomes Center, University Hospitals Case Medical Center, Cleveland, Ohio, USA

    Kathleen A. Smyth

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  1. Joseph B. Babigumira
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Correspondence to Joseph B. Babigumira.

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Babigumira, J.B., Sethi, A.K., Smyth, K.A. et al. Cost Effectiveness of Facility-Based Care, Home-Based Care and Mobile Clinics for Provision of Antiretroviral Therapy in Uganda. Pharmacoeconomics 27, 963–973 (2009). https://doi.org/10.2165/11318230-000000000-00000

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