Cost Effectiveness of a Pharmacy-Only Refill Program in a Large Urban HIV/AIDS Clinic in Uganda
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{"title"=>"Cost effectiveness of a Pharmacy-only Refill Program in a large Urban HIV/AIDS clinic in Uganda", "type"=>"journal", "authors"=>[{"first_name"=>"Joseph B.", "last_name"=>"Babigumira", "scopus_author_id"=>"8418182500"}, {"first_name"=>"Barbara", "last_name"=>"Castelnuovo", "scopus_author_id"=>"9335157500"}, {"first_name"=>"Andy", "last_name"=>"Stergachis", "scopus_author_id"=>"7006802396"}, {"first_name"=>"Agnes", "last_name"=>"Kiragga", "scopus_author_id"=>"25930383500"}, {"first_name"=>"Petra", "last_name"=>"Shaefer", "scopus_author_id"=>"37093937700"}, {"first_name"=>"Mohammed", "last_name"=>"Lamorde", "scopus_author_id"=>"24069027300"}, {"first_name"=>"Andrew", "last_name"=>"Kambugu", "scopus_author_id"=>"24080475700"}, {"first_name"=>"Alice", "last_name"=>"Muwanga", "scopus_author_id"=>"26026383700"}, {"first_name"=>"Louis P.", "last_name"=>"Garrison", "scopus_author_id"=>"7005842958"}], "year"=>2011, "source"=>"PLoS ONE", "identifiers"=>{"sgr"=>"79953135743", "doi"=>"10.1371/journal.pone.0018193", "pui"=>"361518334", "pmid"=>"21464895", "scopus"=>"2-s2.0-79953135743", "issn"=>"19326203", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)"}, "id"=>"46f0fcdc-2584-3231-a0e9-3a5344b6204c", "abstract"=>"BACKGROUND: HIV/AIDS clinics in Uganda and other low-income countries face increasing numbers of patients and workforce shortages. We performed a cost-effectiveness analysis comparing a Pharmacy-only Refill Program (PRP), a form of task-shifting, to the Standard of Care (SOC) at a large HIV/AIDS clinic in Uganda, the Infectious Diseases Institute (IDI). The PRP was started to reduce workforce shortages and optimize patient care by substituting pharmacy visits for SOC involving monthly physician visits for accessing antiretroviral medicines.\\n\\nMETHODOLOGY/PRINCIPAL FINDINGS: We used a retrospective cohort analysis to compare the effectiveness of the PRP compared to SOC. Effectiveness was defined as Favorable Immune Response (FIR), measured as having a CD4 lymphocyte count of over 500 cells/µl at follow-up. We used multivariate logistic regression to assess the difference in FIR between patients in the PRP and SOC. We incorporated estimates of effectiveness into an incremental cost-effectiveness analysis performed from a limited societal perspective. We estimated costs from previous studies at IDI and conducted univariate and probabilistic sensitivity analyses. We identified 829 patients, 578 in the PRP and 251 in SOC. After 12.8 months (PRP) and 15.1 months (SOC) of follow-up, 18.9% of patients had a FIR, 18.6% in the PRP and 19.6% in SOC. There was a non-significant 9% decrease in the odds of having a FIR for PRP compared to SOC after adjusting for other variables (OR 0.93, 95% CI 0.55-1.58). The PRP was less costly than the SOC (US$ 520 vs. 655 annually, respectively). The incremental cost-effectiveness ratio comparing PRP to SOC was US$ 13,500 per FIR. PRP remained cost-effective at univariate and probabilistic sensitivity analysis.\\n\\nCONCLUSION/SIGNIFICANCE: The PRP is more cost-effective than the standard of care. Similar task-shifting programs might help large HIV/AIDS clinics in Uganda and other low-income countries to cope with increasing numbers of patients seeking care.", "link"=>"http://www.mendeley.com/research/cost-effectiveness-pharmacyonly-refill-program-large-urban-hivaids-clinic-uganda", "reader_count"=>87, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Professor > Associate Professor"=>4, "Researcher"=>20, "Student > Doctoral Student"=>8, "Student > Ph. D. Student"=>15, "Student > Postgraduate"=>6, "Student > Master"=>20, "Other"=>4, "Student > Bachelor"=>4, "Lecturer"=>2, "Professor"=>2}, "reader_count_by_user_role"=>{"Unspecified"=>2, "Professor > Associate Professor"=>4, "Researcher"=>20, "Student > Doctoral Student"=>8, "Student > Ph. D. Student"=>15, "Student > Postgraduate"=>6, "Student > Master"=>20, "Other"=>4, "Student > Bachelor"=>4, "Lecturer"=>2, "Professor"=>2}, "reader_count_by_subject_area"=>{"Unspecified"=>8, "Nursing and Health Professions"=>8, "Mathematics"=>1, "Medicine and Dentistry"=>35, "Agricultural and Biological Sciences"=>2, "Philosophy"=>1, "Business, Management and Accounting"=>3, "Pharmacology, Toxicology and Pharmaceutical Science"=>5, "Psychology"=>3, "Social Sciences"=>7, "Computer Science"=>2, "Economics, Econometrics and Finance"=>12}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>35}, "Social Sciences"=>{"Social Sciences"=>7}, "Psychology"=>{"Psychology"=>3}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>12}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>2}, "Computer Science"=>{"Computer Science"=>2}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>8}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>3}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>8}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>5}, "Philosophy"=>{"Philosophy"=>1}}, "reader_count_by_country"=>{"Brazil"=>1, "South Africa"=>1, "United Kingdom"=>2, "France"=>1, "Portugal"=>1}, "group_count"=>6}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/788614"], "description"=>"<p>OR: odd ratio; SOC: standard of care; PRP: Pharmacy Refill Program;\n ART: antiretroviral treatment; d4T: stavudine; 3TC: lamivudine; NVP:\n nevirapine; ZDV: zidovudine; EFV: efavirenz; TDF: tenofovir; FTC:\n emtricitabine; LPV/r: lopinavir/ritonavir; OI: opportunistic\n infection.</p>", "links"=>[], "tags"=>["multivariate", "logistic", "regression", "variables", "follow-up", "cd4", "500"], "article_id"=>458973, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Joseph B. Babigumira", "Barbara Castelnuovo", "Andy Stergachis", "Agnes Kiragga", "Petra Shaefer", "Mohammed Lamorde", "Andrew Kambugu", "Alice Muwanga", "Louis P. Garrison"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0018193.t002", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Univaraite_and_multivariate_logistic_regression_analysis_of_variables____associated_with_follow_up_CD4_cell_count_over_500_cells_ul____n_8202_8202_807_/458973", "title"=>"Univaraite and multivariate logistic regression analysis of variables\n associated with follow-up CD4 cell count over 500 cells/ul\n (n = 807).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 19:39:10"}
  • {"files"=>["https://ndownloader.figshare.com/files/788668"], "description"=>"<p>Inc. – Incremental; ICER: Incremental Cost-Effectiveness\n Ration; FIR – Favorable Immune Response; PRP: Pharmacy-Only\n Refill Program; SOC – Standard of Care.</p><p>*All costs are per person per year.</p>", "links"=>[], "tags"=>["incremental", "probability", "cd4", "500", "cost-effectiveness", "comparing", "prp", "care", "patients", "antiretroviral", "idi"], "article_id"=>459019, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Joseph B. Babigumira", "Barbara Castelnuovo", "Andy Stergachis", "Agnes Kiragga", "Petra Shaefer", "Mohammed Lamorde", "Andrew Kambugu", "Alice Muwanga", "Louis P. Garrison"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0018193.t003", "stats"=>{"downloads"=>3, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Mean_and_incremental_costs_probability_of_CD4_cell_count_over_500____cell_ul_at_1_year_and_cost_effectiveness_comparing_PRP_and_standard_care____in_patients_on_antiretroviral_treatment_at_the_IDI_clinic_Kampala____Uganda_/459019", "title"=>"Mean and incremental costs, probability of CD4 cell count over 500\n cell/ul at 1 year and cost-effectiveness comparing PRP and standard care\n in patients on antiretroviral treatment at the IDI clinic, Kampala,\n Uganda.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 19:39:25"}
  • {"files"=>["https://ndownloader.figshare.com/files/788364"], "description"=>"<p>Tornado diagram of univariate sensitivity analysis showing the impact\n on incremental costs comparing Pharmacy-only Refill Program (PRP) versus\n Standard of Care (SOC).</p>", "links"=>[], "tags"=>["diagram", "univariate", "impact", "incremental", "costs", "comparing", "pharmacy-only", "refill", "versus"], "article_id"=>458713, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Joseph B. Babigumira", "Barbara Castelnuovo", "Andy Stergachis", "Agnes Kiragga", "Petra Shaefer", "Mohammed Lamorde", "Andrew Kambugu", "Alice Muwanga", "Louis P. Garrison"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0018193.g001", "stats"=>{"downloads"=>1, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Tornado_diagram_of_univariate_sensitivity_analysis_showing_the_impact____on_incremental_costs_comparing_Pharmacy_only_Refill_Program_PRP_versus____Standard_of_Care_SOC_/458713", "title"=>"Tornado diagram of univariate sensitivity analysis showing the impact\n on incremental costs comparing Pharmacy-only Refill Program (PRP) versus\n Standard of Care (SOC).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 19:37:43"}
  • {"files"=>["https://ndownloader.figshare.com/files/788567"], "description"=>"a<p>All data are n (%) or mean (SD).</p><p>*Includes d4T-3TC-EFV, ZDV-3TC-NVP, NVP-TDF-3TC, ZDV-ddI-LPV/r,\n ZDV-3TC-LPV/r, ddI-d4T-LPV/r, ZDV-EFV-LPV/r, 3<sup>rd</sup> line\n drugs and unknown drugs.</p><p>**Includes D4T-3TC-NVP, D4T-3TC-EFV, TDF-FTC-EFV,\n NVP-TDF-3TC, TDF-FTC-NVP, ZDV-DDI-LPV/r, ZDV-3TC-LPV/r,\n DDI-D4T-LPV/r, TDF-FTC-LPV/r, ZDV-TDF-LPV/r, ZDV-3TC-DDI-LPV/r ,\n TDF-EFV-LPV/r, 3TC-NVP-LPV/r and other 3<sup>rd</sup> line\n drugs.</p>Ψ<p>N = 807.</p><p>SOC: standard of care; PRP: Pharmacy Refill Program; ART:\n antiretroviral treatment; d4T: stavudine; 3TC: lamivudine; NVP:\n nevirapine; ZDV: zidovudine; EFV: efavirenz; TDF: tenofovir; FTC:\n emtricitabine; LPV/r: lopinavir/ritonavir; OI: opportunistic\n infection.</p>", "links"=>[], "tags"=>["characteristics", "study"], "article_id"=>458936, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Joseph B. Babigumira", "Barbara Castelnuovo", "Andy Stergachis", "Agnes Kiragga", "Petra Shaefer", "Mohammed Lamorde", "Andrew Kambugu", "Alice Muwanga", "Louis P. Garrison"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0018193.t001", "stats"=>{"downloads"=>3, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Demographic_clinical_and_laboratory_characteristics_of_the_study____population_by_method_of_follow_up_a_/458936", "title"=>"Demographic, clinical and laboratory characteristics of the study\n population by method of follow-up<sup>a</sup>.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 19:38:58"}
  • {"files"=>["https://ndownloader.figshare.com/files/788445"], "description"=>"<p>Scatter plot of estimated joint density of incremental costs and\n incremental effects of Pharmacy-only Refill Program (PRP) versus\n Standard of Care (SOC) by Monte Carlo simulation.</p>", "links"=>[], "tags"=>["incremental", "costs", "and", "pharmacy-only", "refill", "versus", "monte", "carlo"], "article_id"=>458802, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Joseph B. Babigumira", "Barbara Castelnuovo", "Andy Stergachis", "Agnes Kiragga", "Petra Shaefer", "Mohammed Lamorde", "Andrew Kambugu", "Alice Muwanga", "Louis P. Garrison"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0018193.g002", "stats"=>{"downloads"=>1, "page_views"=>16, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Scatter_plot_of_estimated_joint_density_of_incremental_costs_and____incremental_effects_of_Pharmacy_only_Refill_Program_PRP_versus____Standard_of_Care_SOC_by_Monte_Carlo_simulation_/458802", "title"=>"Scatter plot of estimated joint density of incremental costs and\n incremental effects of Pharmacy-only Refill Program (PRP) versus\n Standard of Care (SOC) by Monte Carlo simulation.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 19:38:13"}
  • {"files"=>["https://ndownloader.figshare.com/files/788517"], "description"=>"<p>Cost-effectiveness acceptability curve showing the probability that\n Pharmacy-only Refill Program (PRP) or Standard of Care (SOC) is\n cost-effective compared to the other over a range of values of\n willingness to pay.</p>", "links"=>[], "tags"=>["acceptability", "probability", "that", "pharmacy-only", "refill", "is", "cost-effective", "compared", "of"], "article_id"=>458879, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Joseph B. Babigumira", "Barbara Castelnuovo", "Andy Stergachis", "Agnes Kiragga", "Petra Shaefer", "Mohammed Lamorde", "Andrew Kambugu", "Alice Muwanga", "Louis P. Garrison"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0018193.g003", "stats"=>{"downloads"=>0, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cost_effectiveness_acceptability_curve_showing_the_probability_that____Pharmacy_only_Refill_Program_PRP_or_Standard_of_Care_SOC_is____cost_effective_compared_to_the_other_over_a_range_of_values_of____willingness_to_pay_/458879", "title"=>"Cost-effectiveness acceptability curve showing the probability that\n Pharmacy-only Refill Program (PRP) or Standard of Care (SOC) is\n cost-effective compared to the other over a range of values of\n willingness to pay.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 19:38:38"}

PMC Usage Stats | Further Information

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Relative Metric

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