Cost-Effectiveness of Nurse-Managed ART for Stable HIV Patients in South Africa
Author Information
Author(s): Lawrence Long, Alana Brennan, Matthew P. Fox, Buyiswa Ndibongo, Imogen Jaffray, Ian Sanne, Sydney Rosen
Primary Institution: Health Economics and Epidemiology Research Office, Wits Health Consortium, Johannesburg, South Africa
Hypothesis
Shifting management of stable ART patients from doctors to nurses will provide comparable health outcomes and lower costs.
Conclusion
Down-referring stable ART patients to nurse-managed clinics results in better health outcomes and lower costs compared to hospital-based doctor-managed care.
Supporting Evidence
- Down-referred patients had a 1.7% death rate compared to 6.2% for those who remained in hospital care.
- The average cost per patient-year was $492 for down-referred patients versus $551 for those in hospital care.
- 95.5% of down-referred patients remained in care and responding after 12 months.
Takeaway
This study shows that having nurses take care of stable HIV patients is cheaper and just as effective as having doctors do it.
Methodology
The study compared outcomes and costs of stable ART patients down-referred from a doctor-managed clinic to a nurse-managed primary health clinic.
Potential Biases
Potential unmeasured factors may have influenced outcomes between the two patient groups.
Limitations
The study was conducted at only one pair of sites, which may not be representative of other facilities in South Africa.
Participant Demographics
{"mean_age":38.5,"sex_percent_female":65.4}
Statistical Information
P-Value
p<0.0001
Confidence Interval
95% CI 0.15–0.49
Statistical Significance
p<0.0001
Digital Object Identifier (DOI)
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