Cost Effectiveness of Peer Supported Group Intervention Program Among HIV Treated Patients in Outpatient Clinics in Vietnam.

Abstract

This paper analyzes the cost of providing a peer-support group intervention from the society’s perspective, measures the effects of the intervention among HIV infected adults and children in Vietnam, and employs the method of incremental cost effectiveness ratio to quantity the economic impact of the intervention. This study considers two study cohorts: adult and children cohorts. In the (HIV-infected) adult cohort which was already completed, the principal peer-support group intervention was the provision of home visits. Data on the adult cohort include baseline data as well as data on the subsequent 24 months of follow-up. Health outcomes of interest are the drug adherence rate, the percentage of non-viral failure cases and disability adjusted live years (DALYs). In the (HIV-infected) children cohort, which is still ongoing, the main intervention has been the provision of phone calls. Data on the children cohort include baseline data as well as data on the subsequent 16 months of follow-up. Health outcomes of interest are the drug adherence rate and the percentage of non-viral failure cases. In each cohort, enrolled patients were randomly assigned into either the control group where the peer-support group intervention is not provided or the intervention group in which the intervention is provided. The costing analysis involves expenditures from the patient’s, the provider’s and the purchaser’s perspective, where the purchaser in this case refers to NGOs who provide funding for the intervention. The total unit cost is estimated using a top-down approach with discounting techniques taken into consideration as the data analyzed span over the period of one year. Cost-effectiveness analyses are also performed, with the cost effectiveness ratio being the average total cost divided by the respective health outcome. The study finds that, for the control and the intervention groups within the adult cohort, the average unit costs are $86.95 and $72.64. The incremental cost effectiveness ratios per 1% drug adherence rate and per one DALY reduced are $2,947 and $1,706 respectively. The ratio is not significant for the percentage of non-viral failure cases. For the control and the intervention groups within the children cohort, the average unit costs are $185 and $136 respectively and the incremental cost effectiveness ratio proves to be insignificant for all health outcomes considered for the children cohort.