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| Title: | Cost Effectiveness of a Pharmacy-Only Refill Program in a Large Urban HIV/AIDS Clinic in Uganda |
| Authors: | Babigumira, Joseph B.
Castelnuovo, Barbara
Stergachis, Andy
Kiragga, Agnes
Shaefer, Petra
Lamorde, Mohammed
Kambugu, Andrew
Muwanga, Alice
Garrison, Louis P. |
| Keywords: | Cost Effectiveness
Pharmacy
HIV/AIDS Clinic
Retrospective cohort |
| Issue Date: | 28-Mar-2011 |
| Publisher: | Public Library of Science |
| Citation: | Babigumira J. e tal. (2011). Cost Effectiveness of a Pharmacy-Only Refill Program in a Large Urban HIV/AIDS Clinic in Uganda. PLoS ONE, 6(3):E18193 |
| Abstract: | Background: HIV/AIDS clinics in Uganda and other low-income countries face increasing numbers of patients and
workforce shortages. We performed a cost-effectiveness analysis comparing a Pharmacy-only Refill Program (PRP), a form of
task-shifting, to the Standard of Care (SOC) at a large HIV/AIDS clinic in Uganda, the Infectious Diseases Institute (IDI). The
PRP was started to reduce workforce shortages and optimize patient care by substituting pharmacy visits for SOC involving
monthly physician visits for accessing antiretroviral medicines.
Methodology/Principal Findings: We used a retrospective cohort analysis to compare the effectiveness of the PRP
compared to SOC. Effectiveness was defined as Favorable Immune Response (FIR), measured as having a CD4 lymphocyte
count of over 500 cells/ml at follow-up. We used multivariate logistic regression to assess the difference in FIR between
patients in the PRP and SOC. We incorporated estimates of effectiveness into an incremental cost-effectiveness analysis
performed from a limited societal perspective. We estimated costs from previous studies at IDI and conducted univariate
and probabilistic sensitivity analyses. We identified 829 patients, 578 in the PRP and 251 in SOC. After 12.8 months (PRP) and
15.1 months (SOC) of follow-up, 18.9% of patients had a FIR, 18.6% in the PRP and 19.6% in SOC. There was a non-significant
9% decrease in the odds of having a FIR for PRP compared to SOC after adjusting for other variables (OR 0.93, 95% CI 0.55–
1.58). The PRP was less costly than the SOC (US$ 520 vs. 655 annually, respectively). The incremental cost-effectiveness ratio
comparing PRP to SOC was US$ 13,500 per FIR. PRP remained cost-effective at univariate and probabilistic sensitivity
analysis.
Conclusion/Significance: The PRP is more cost-effective than the standard of care. Similar task-shifting programs might
help large HIV/AIDS clinics in Uganda and other low-income countries to cope with increasing numbers of patients seeking
care. |
| Description: | The authors have declared that no competing interests exist. |
| URI: | http://dx.doi.org/10.1371/journal.pone.0018193
http://hdl.handle.net/123456789/1901 |
| ISSN: | 1932-6203 |
| Appears in Collections: | Research Articles (IDI)
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| Babigumira-J-idi-res2.pdf | | 471Kb | Adobe PDF | View/Open |
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