Social and Economic costs of HIV and AIDS. Current issues. Sarah Ann Adomakoh. Costs, cost-effectiveness & Sustainability

Transcription

1 Associates for International Development Social and Economic costs of HIV and AIDS Current issues Suite A East Wing ARS Medicae Building No. 14, 6 th Avenue, Belleville St Michael Barbados Tel (246) Fax (246) training@aidincorporated.org Costs, cost-effectiveness & Sustainability Sarah Ann Adomakoh

2 Low prevalence estimates indicate, 2 new cases every 3 days, but estimates are as high as 1 new HIV case every 30 hours

3 Human suffering Morbidity 1980s to 2000 Impact of AIDS - lost lives & livelihoods Social functioning Participation- reduced output Reduced Quality of life Loss of human capital Increased and unexpected mortality in productive agegroup Reduced Transmission of abilities to next generation Child rearing

4 HIV/AIDS & the Economic System Social capital Public/Private Expenditure Actual health expenditure Required health expenditure Supply of labour GDP Savings/capital Illness or Death HIV/AIDS Prevention & Treatment

5 Economic impact on affected households Before HAART, out of pocket household expenditure due to treatment of HIV/AIDS is an average of 28-62% of annual household income for various subgroups, ranging from 24% for those covered by social welfare and 76% for those not covered Post HAART - In 2004 the range narrowed: 10% to 35% Survey Data demonstrated following reasons; Household income did not rise (no return to work) and expenditure fell due to free access Household income fell further and expenditure fell due to lack of funds and unmet needs

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7 Slide 6 AJ9 Sarah You just need to make passing reference to this slide and point to the exact location on the graph where you are making the comparison Alies Jordan; 14/10/2005

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9 Microeconomic and macroeconomic, impact on development. - Microeconomic impact on households, families, local/ regional food production, and productivity of various economic sectors. - Macroeconomic models to take into account the impact on human capital.

10 A new Era The Cost of Sustaining lives through Treatment

11 Sexual practices, mixing Reduction in deaths by 42% and maintaining this trend- overall apprx. 73% reduction in deaths between 2001 and 2004 Transmission probabilities - effectiveness of viral suppression Access to treatment & VCT Prevention efforts Those who don t know are almost 2 thirds of those with HIV!!!

12 Reported cases - PLWHA

13 Impact issues on Universal access to ARV Treatment, care,support - Are we maximising efficiency in the delivery of our programs? Maximising outcomes? cost savings, benefits and cost effectiveness Minimizing costs? What is an adequate drug pricing strategy for Barbados Service scope? The right balance: Integratign within exisiting services and prevention programmes Shared care between private and public settings Effective and Community care approaches Shared staff within institutions - Balance of Coverage - Are we promoting equity in access to ART? Enabling environment promote more trust, respect, less stigma, discrimination, rejection Equity of access for higher SES: reverse sitiation most developing contries Making patients pay can reduce effectivenss of outcomes Equity of access for kep populations - effect of Stigma discrimination in households and health care settings Can we sustain a positive impact of ARVs on the epidemic at minimised cost to minimise negative impacts? Sustainability plans: health financing and investments What are the other global impacts of the universal program ( accoridng to current and planned configurations) on public health, economic, social and human development?

14 Incremental costs analysis Pre HAART HAART Programme Difference Programme Inpatient costs $1,367,964 $810,045 ($557,919) HAART $631,134 $707,596 $76,462 OI drugs $100,209 $156,220 $56,011 ($600,734) Outpatient visit cost $94,533 $418,480 $323,947 Outpatient diagnostics $35, $258,200 $222, Net Incremental cost $120,735 net cost per patient $ net cost per patient per $32.14 ($556,461) month ($1464) ($122)

15 Increasing cost of HAART Ladymead Reference Unit 2004 ARV Total Qty Un Price BBD Total Exp. BBD Epivir (lamivudine) 3TC 800 $43.07 $34,456 Combivir (zidovudine/lamivudine) AZT/3TC 2,292 $ $315,425 Retrovir (zidovudine) AZT 75 $ $7,617 Sustiva TM (efavirenz/stocrin) 2,487 $ $447,411 Videx (didanosine) 100 mg 540 $34.40 $18,576 Viramune (nevirapine) 342 $82.57 $28,239 Viracept (nelfinavir mesylate) 190 $ $115,486 Zerit (staduvine) d4t 30 mg 272 $64.54 $17,555 Zerit (staduvine) d4t 40 mg 888 $86.01 $76,377 Videx (didanosine) 25 mg 16 $29.94 $479 Crixivan (indinavir sulfate) 378 $ $79,070 Ziagen TM (abacavir sulfate) 340 $ $92,800 Kaletra TM (lopinavir/ritonavir) 574 $ $563,209 Total 9,194 $1,796,699

16 No. of clients followed up and on HAART at the LRU No Year No. of clients followed up No. of clients on HAART

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18 Outcomes: Key Findings Overall reduction in deaths of clinic registered patients by approximately 56% Median CD4 rise of over 100cells/mm3 observed in AIDS patients 85% of patients achieving greater than 95% adherence (LB41) Baseline total cost of inpatient care for HIV patients is $1,367,964 compared with the inpatient cost post HAART of $810,045 (02/3) $457,391 (03/4); $465,052 (04/5) Therefore, cost of inpatient care reduced by 40.8% in first year and 66% between 2001 and Rise in patients attending clinic from apprx. 380 to 744 between 2003 to 2004 Overall reduction in AIDS related events observed in clinic attendees Rise in outpatient visits by 128% Reduction in death rate 18 months by 42% Apprx. Incremental cost effe9ctiveness ratio: $2171 per death averted (life year saved in 2002) increased to $13,173 per death averted between 2002 and 2004.

19 Sustainability- Clinical effectiveness is not enough!! Direct Benefits Potential reductions in hospitalization costs Prevention - Potential reductions in new infections due to lower viral loads Indirect Benefits Increased Quality of Life? Increased productivity of the labour force Increased stability and longevity of families - child rearing, impact on next generation sustainable development Returns on investment Increased economic and social Productivity and increased saving Shared costs Increase client base to wider population beyond borders for cost recovery Reduce impact to other sectors Save money

20 HRQoL Short Form 29-item item-barbados (SF29-Bds.) Measures Physical and Mental Components of Health

21 Issues of Concern to Employers in the ARV Treatment Era Stigma: Life years lost due to mental health impact of non-disclosure of employees Over 30% of employed PLWHA leave workforce long before health effects take hold. Average up to 2 years before AIDS onset 13% left as result of enacted stigma or overt discrimination Almost 20% would not disclose, manifested social cost in terms of reduced mental health and quality of life Economic: mental health problems reduced quality and output Employer denial of threat of HIV self stigma enforces failure to act Refusal to face the cost of mitigation - what will it cost? Insurance firms may feel no impact due to failure to claim through company health plans (delayed effect of stigma) Households spendings and savings decline instead Impact of delayed stigma in higher SES on sectors and economy is lethal and profound

22 Employee level impact- what lies beneath? Staff won t die, but Due to all forms of stigma and discrimination.. Partial or complete withdrawal from social and economically productive life mental health impact is observed.poor Quality of Life Leading to Pressure on existing workers reduced output, days lost from work due to self stigma. Low self esteem, vitality and poor mental health as a result of non disclosure and inability opt openly seek effective counseling support Will reduce levels and quality of output

23 Strategies for Reducing the Burden on Employers Diminish the size of the burden. Invest in HIV prevention interventions. Invest in HIV/AIDS care and treatment interventions. Invest in replenishment of human capital (training). Shift the burden onto others Only sure costeffective response CE depends on cost of treatment, survival rate, level of employee, etc Mitigation strategy to provide staff back up - need s close assessment off at risk workers to be CE

24 The Greatest Threat - Stigma & Discrimination Source: S Adomakoh PhD Thesis

25 The case of William, age 35 What do you do to relieve your depression? When I get depressed I take a long walk from the hostel to Browns Beach and walk on the beach instead Instead of what? Instead of the alternative (laughs and throws head back) Which is what? I would get a gun and put it to my head.but I am trying to stay alive to see my 13 year boy graduate he is much cleverer than I was and has a future William was also abusing substances to self treat his depression. This ranged from Marijuana, to crack to pethadine. He was also on HAART. William died 2 weeks later.

26 Increased Cost-effectiveness optimize therapeutic strategies depends on : Optimal pricing of brand name drugs (non-generics) Use of generic drugs. Increased tolerance, adherence, and acceptability of treatment (increased life years saved) 85% of patients achieving greater than 95% adherence Enabling environment Policies regarding health fencing, equity of access issues Increased numbers of asymptomatic HIV and HIV negative patients attracted to the new programme through a strengthened voluntary counseling and testing (VCT/prevention) service Contact tracing Improved referral networks Support to PLWHA - Responsive welfare policies and progammes

27 Enabling Environment & Access to Effective Prevention,ARV, Care Welfare programmes to improve QoL Improved equity of access to ARVs Support intensity may reduce over time Increased services provision Policy directives Stigma reduction Well Being Health Support Treatment & Care Prevention Trust Enabling Environment Sustained improved Productivity Sustained improved outcomes ARV coverage ARV Monitoring Support intensity Community support STI service use VCT increase targeted progs. Increased demand by key pop ns & others