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Economic costs and health-related quality of life outcomes of hospitalised patients with high HIV prevalence : a prospective hospital cohort study in Blantyre, Malawi
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Maheswaran, Hendramoorthy, Petrou, Stavros, Cohen, D., MacPherson, Peter, Kumwenda, F., Laloo, D. G., Corbett, Elizabeth L. and Clarke, Aileen (2018) Economic costs and health-related quality of life outcomes of hospitalised patients with high HIV prevalence : a prospective hospital cohort study in Blantyre, Malawi. PLoS One, 13 (3). e0192991. doi:10.1371/journal.pone.0192991 ISSN 1932-6203.
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Official URL: https://doi.org/10.1371/journal.pone.0192991
Abstract
Introduction
Although HIV infection and its associated co-morbidities remain the commonest reason for hospitalisation in Africa, their impact on economic costs and health-related quality of life (HRQoL) are not well understood. This information is essential for decision-makers to make informed choices about how to best scale-up anti-retroviral treatment (ART) programmes. This study aimed to quantify the impact of HIV infection and ART on economic outcomes in a prospective cohort of hospitalised patients with high HIV prevalence.
Methods
Sequential medical admissions to Queen Elizabeth Central Hospital, Malawi, between June-December 2014 were followed until discharge, with standardised classification of medical diagnosis and estimation of healthcare resources used. Primary costing studies estimated total health provider cost by medical diagnosis. Participants were interviewed to establish direct non-medical and indirect costs. Costs were adjusted to 2014 US$ and INT$. HRQoL was measured using the EuroQol EQ-5D. Multivariable analyses estimated predictors of economic outcomes.
Results
Of 892 eligible participants, 80.4% (647/892) were recruited and medical notes found. In total, 447/647 (69.1%) participants were HIV-positive, 339/447 (75.8%) were on ART prior to admission, and 134/647 (20.7%) died in hospital. Mean duration of admission for HIV-positive participants not on ART and HIV-positive participants on ART was 15.0 days (95%CI: 12.0–18.0) and 12.2 days (95%CI: 10.8–13.7) respectively, compared to 10.8 days (95%CI: 8.8–12.8) for HIV-negative participants. Mean total provider cost per hospital admission was US$74.78 (bootstrap 95%CI: US$25.41-US$124.15) higher for HIV-positive than HIV-negative participants. Amongst HIV-positive participants, the mean total provider cost was US$106.87 (bootstrap 95%CI: US$25.09-US$106.87) lower for those on ART than for those not on ART. The mean total direct non-medical and indirect cost per hospital admission was US$87.84. EQ-5D utility scores were lower amongst HIV-positive participants, but not significantly different between those on and not on ART.
Conclusions
HIV-related hospital care poses substantial financial burdens on health systems and patients; however, per-admission costs are substantially lower for those already initiated onto ART prior to admission. These potential cost savings could offset some of the additional resources needed to provide universal access to ART.
Item Type: | Journal Article | ||||||||||||
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Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | HIV infections -- Patients -- Hospital care -- Cost effectiveness -- Malaŵi | ||||||||||||
Journal or Publication Title: | PLoS One | ||||||||||||
Publisher: | Public Library of Science | ||||||||||||
ISSN: | 1932-6203 | ||||||||||||
Official Date: | March 2018 | ||||||||||||
Dates: |
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Volume: | 13 | ||||||||||||
Number: | 3 | ||||||||||||
Article Number: | e0192991 | ||||||||||||
DOI: | 10.1371/journal.pone.0192991 | ||||||||||||
Status: | Peer Reviewed | ||||||||||||
Publication Status: | Published | ||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||
Date of first compliant deposit: | 19 February 2018 | ||||||||||||
Date of first compliant Open Access: | 23 February 2018 | ||||||||||||
RIOXX Funder/Project Grant: |
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