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 Clinics 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
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.