TABLE COST OF HIV/AIDS - 1: SUMMARY INFORMATION

Background

This table provides a template for a “quick and dirty” estimate of HIV/AIDs treatment costs. Studies that thoroughly cost out all the resources needed to care for HIV/AIDS patients are fairly rare. More common are efforts to calculate the quantity of care provided, often at just one health facility. For example, some studies tabulate the number of outpatient visits and the number of hospital days for each HIV/AIDS patient or for each episode of HIV/AIDS illness. You may be able to obtain information from other sources such as reports produced by the Ministry of Health or academic institutions on the average cost per outpatient visit or inpatient day. By multiplying each service unit by the cost per unit one can arrive at a total cost estimate. Data sources: Among the few published estimates of the lifetime discounted cost of care for pediatric AIDS are $396 based on estimates from Tanzania and Zaire (Mansergh, 1998); $195 for Tanzania (Pallango and Laing, 1990) and $3,300 for Thailand (Walker, 1997).

A critical issue is correctly identifying public sector costs. Here are examples of the concerns you should be aware of:

1. A study performed in a public hospital may not include the cost of services provided by an NGO or a satellite public clinic before the patient came to the hospital. This would result in an underestimate of real public sector costs.

2. Some percentage of AIDS patients may obtain care from private physicians and clinics. Assuming that all AIDS patients are cared for in the public sector would overestimate the public sector share.

3. Some items that may be counted as public sector costs shouldn’t be. For example, drug costs may actually be paid by patients or their families.

4. Registration fees and other charges that generate revenues for the service provider should be deducted from costs in order to arrive at the correct net public cost.

It may be worthwhile to speak with the Medical Director or Chief Administrator of the large urban hospitals in your country. He or she may know of HIV/AIDS cost studies or may be able to refer you to someone who does. The Office of AIDS in the MOH may also have compiled some information on resources allocated to HIV/AIDS care. The MOH might also have an expert on the mix of public, private insurance, and out-of-pocket spending for health care.

Another approach is based on the observed correlation between per-case HIV expenditures (both private and public sector) and per-capita GNP. Expenditures vary from between 0.6 times per-capita GNP in Tanzania to 3.0 times per-capita GNP in Sao Paulo (Shepard, 1997). Another survey of five developing countries suggests that the average is about 1.5 times per-capita GNP. (Martin, 1996). Since the expenditure data includes both public and private sector, the final figure would have to be adjusted by an estimate of the portion that public sector expenditures constitute of total public/private expenditures. Because this method depends on broad ratios which may not be very precise for your setting, this method should only be used if others are impractical.

C18. Enter “D” or “S”. The left portion of this table is unmasked if you opt to use the summary method of evaluating HIV/AIDS costs. (Enter “S” for “Summary” in cell “Cost of HIV/AIDS” C18). If “D” (“Detailed”) in cell “HIV/AIDS” C18 is selected the right portion of the table is unmasked. This right-hand portion of Table Cost of HIV/AIDS-1 shows you the results of the detailed analysis performed in Table Cost of HIV/AIDS-2. Table Cost of HIV/AIDS-2 is only unmasked if you select the more detailed approach to the cost analysis by entering “D” in cell C18.

F24. Enter a single best estimate for the discounted lifetime cost of treating a case of pediatric HIV/AIDS.

F27. Cells E24 and G24 of Table Cost of HIV/AIDS-1 provide a low and high range around the best estimate. This range is defined by the percentage you enter in F27.