Sunday 24th September, 2006


Clinic provides cost-effective care

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Raymond Noel, MD, MPA

HIV Specialist, Tobago Health Promotion Clinic Cost questions have always plagued HIV/Aids interventions. The true benefits of treatment and prevention programmes could be seen from looking at the cost of inaction.

This would amplify the loss of human resources by morbidity and death, create orphans, overwhelm our health and social services, decrease the number of teachers, healthcare workers; actions that would lead to social and financial crisis and in the long run possible political instability.

The Health Promotion Clinic’s programmes directed at fighting the epidemic are cost avoiding, cost saving and cost effective. Prior to 2003 HIV/Aids related admissions to Scarborough Regional Hospital accounted for up to five per cent of admissions. The length of stay of these patients was extended averaging about 11 days (according to patient reports). Their consumption of hospital goods and services is 40 per cent greater than a non HIV related admission (from US hospital estimates).

At present, since patients are being treated from the community and hospitalised patients are referred to the clinic for care and treatment, hospital admission for HIV/Aids are down by 83 per cent and thus cost for HIV related illness in Tobago presently should be at least 75 per cent less than before the clinic was established in 2004.

Anti-retroviral therapy has extended the lives and added years of productive employment and tax paying to HIV/Aids patients in Tobago who are again employable and able to go back to work.

So far the clinic has added 510 patient years to the lives of HIV patients in Tobago. Of the patients who presented with Aids (168), without the clinic because the time from diagnosis to death would have been eight months, 85 per cent or 143 would have died.

At present, 91 per cent of these are alive and well. The social value of this life extension is also reflected in the fact that Aids orphan creation is also decreased.

In the US the incremental cost per quality adjusted year of life is $23,000 for HIV/Aids patients. These values are not available for Tobago. But consider that if you take absolute values and apply same to Tobago, this would be 23,000 by 510 or a saving of $11.7 million in cost avoidance for HIV/Aids related healthcare costs.

Anti-retroviral therapy in Tobago has been cost effective and cost saving. Therapy is expensive but the direct and indirect cost of not treating are extremely higher.

Treatment delays the onset of opportunistic infections and hospitalisation and prevent the use of more expensive drugs and diagnostic services.

Treated patients are associated with fewer hospital admissions, less expensive in hospital care and treatment, less need for homecare and wiser use of provided health care services.

Treatment also prevents or decreases the risk of these 178 patients further spreading the disease. These savings by far off set the increased out patient costs associated with HIV/Aids care.

At the clinic we have managed and delivered 16 HIV/Aids negative babies to Tobago. Estimating that the lifetime cost for care and treatment of an HIV/Aids baby is over $4 million, the cost avoidance figure is $64 million.


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