Impact and economic evaluation of a novel HIV service delivery model in rural Malawi. (10th September 2017)

• Record Type: Journal Article
• Authors: McBain, Ryan K.; Petersen, Elizabeth; Tophof, Nora; Dunbar, Elizabeth L.; Kalanga, Noel; Nazimera, Lawrence; Mganga, Andrew; Dullie, Luckson; Mukherjee, Joia; Wroe, Emily B.
• Is Part Of: AIDS. Volume 31:Number 14(2017)
• Publication Date: 2017-09-10
• Subjects: cost-effectiveness analysis -- health policy -- HIV/AIDS -- implementation science -- population-based analysis; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000001578
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : Objective: We performed an impact and cost-effectiveness analysis of a novel HIV service delivery model in a high prevalence, remote district of Malawi with a population of 143 800 people. Design: A population-based retrospective analysis of 1-year survival rates among newly enrolled HIV-positive patients at 682 health facilities throughout Malawi, comparing facilities implementing the service delivery model ( n = 13) and those implementing care-as-usual ( n = 669). Methods: Through district-level health surveillance data, we evaluated 1-year survival rates among HIV patients newly enrolled between July, 2013 and June 2014 – representing 129 938 patients in care across 682 health facilities – using a multilevel modeling framework. The model, focused on social determinants of health, was implemented throughout Neno District at 13 facilities and compared with facilities in all other districts. Activity-based costing was used to annualize financial and economic costs from a societal perspective. Incremental cost-effectiveness ratios were expressed as quality-adjusted life-years gained. Results: The national average 1-year survival rate for newly enrolled antiretroviral therapy clients was 78.9%: this rate was 87.9% in Neno District, compared with 78.8% across all other districts in Malawi ( P < 0.001; 95% confidence interval: 0.079–0.104). The economic cost of receiving care in Neno district ( n = 6541 patients) was $317/patient/year, compared with an estimated $219/patient in other districts. This translated to $906 per quality-adjusted life-year gained. Conclusion: Neno District's comprehensive model of care, featuring a strong focus on the community, is $98 more expensive per capita per annum but demonstrates superior 1-year survival rates, despite its remote location. Moreover, it should be considered cost-effective by traditional international standards.