TABLE SF - 5: HIV AND NON-HIV MEDICAL COSTS

Background

Substitute feeding is likely to produce two effects on health costs. The intended reduction in HIV transmission generates savings in HIV treatment costs. The unintended effect of increased non-HIV disease (both mortality and morbidity) increases medical costs. This table estimates both effects.

Influence on cost-effectiveness: High. These data are important to calculate cost-effectiveness. They help determine the net costs of substitute feeding

Expected effort of data collection: Medium-high. Much data may be available locally (e.g., outpatient and inpatient utilization and costs).

D95 - H96. HIV medical costs averted. Based on the discounted lifetime cost of treating pediatric HIV/AIDS as calculated in the “Cost of HIV/AIDS” sheet and the number of HIV cases averted through substitute feeding, this section estimates savings in HIV-related medical costs associated with substitute feeding. No data entry is required.

D99 - H99. Ratio of non-HIV medical costs with substitute feeding program vs. current non-HIV medical costs. This equals the ratio of non-HIV deaths if women observe current feeding practices to non-HIV deaths if women choose the substitute feeding option.

Thus, the model assumes that non-HIV medical costs are proportional to non-HIV mortality. No data entry is required.

D101 - H101. Usual number of outpatient sick visits in 12 months. Be sure to exclude well-baby visits and visits due to HIV. Include the net cost to the public sector payor only. Data sources: This data may be available from children’s health cards, possibly records at a local hospital or clinic, or special studies that may have been done. If not, it can be derived less formally (and less accurately) by interviewing doctors or auxiliary health professionals who treat infants in your area.

D102 - H102. Cost/outpatient visit (including medications; public sector share). This is the unit cost of a sick visit. Data sources: This information may be available in documents produced by particular hospitals or by the Ministry of Health. If not, a reasonable estimate can be obtained by multiplying the average time per outpatient visit and multiplying this by the medical staff’s compensation rate including benefits. To this should be added the average cost of medications provided net of the patients’ share of medication costs.

D103 - H103. Added number of outpatient sick visits due to substitute feeding. This estimate is based on the ratio of non-HIV mortality in the children of women following current feeding versus substitute feeding (D99 - H99). The CET applies this ratio to the usual number of outpatient visits (D101 - H101). No data entry is required.

D104 - H104. Cost for added outpatient visits. These figures are the product of the added number of outpatient visits multiplied by the average cost per outpatient visit. No data entry is required.

D106 - H106. Usual number of inpatient stays in 12 months. This is number of hospital stays in the first year of life. Data sources: Similar to outpatient visits (Row 101).

D107 - H107. Cost per inpatient stay (public sector share only). This is the unit cost of a hospital stay. Data sources: This may be available from special studies or published reports. Otherwise, you will need to obtain estimates by interviewing hospital administrators and/or examining a sample of medical records.

D108 - H108. Added number of inpatient stays due to substitute feeding. This estimate is done similarly as the estimate for outpatient visits in row 100. No data entry is required.

D109 - H109. Cost for added inpatient stays. These figures are the product of the added number of inpatient stays multiplied by the average cost per inpatient stay. No data is entry required.

D111 - H111. Cost of contraception per woman (public sector share only). Enter the average cost of contraception that may be provided to women as part of the substitute feeding program. We assume $10 as the default value.

D113 - H113. Non-HIV costs added, per 100 HIV+ mothers who chooses substitute feeding. These estimates are totals of the values above. No data entry is required.

D114 - H114. TOTAL NET MED. COSTS, per 100 HIV+ mothers who choose substitute feeding. These figures represent the savings in HIV medical costs minus the increased medical costs due to elevated non-HIV morbidity and mortality. No data entry is required.