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Cost-Effectiveness of Improving Health Care to People with HIV in Nicaragua

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  • Edward Broughton
  • Danilo Nunez
  • Indira Moreno

Abstract

Background . A 2010 evaluation found generally poor outcomes among HIV patients on antiretroviral therapy in Nicaragua. We evaluated an intervention to improve HIV nursing services in hospital outpatient departments to improve patient treatment and retention in care. The intervention included improving patient tracking, extending clinic hours, caring for children of HIV+ mothers, ensuring medication availability, promoting self-help groups and family involvement, and coordinating multidisciplinary care. Methods . This pre/postintervention study examined opportunistic infections and clinical status of HIV patients before and after implementation of changes to the system of nursing care. Hospital expenditure data were collected by auditors and hospital teams tracked intervention expenses. Decision tree analysis determined incremental cost-effectiveness from the implementers’ perspective. Results . Opportunistic infections decreased by 24% (95% CI: 14%–34%) and 11.3% of patients improved in CDC clinical stage. Average per-patient costs decreased by $133/patient/year (95% CI: $29–$249). The intervention, compared to business-as-usual strategy, saved money while improving outcomes. Conclusions . Improved efficiency of services can allow more ART-eligible patients to receive therapy. We recommended the intervention be implemented in all HIV service facilities in Nicaragua.

Suggested Citation

  • Edward Broughton & Danilo Nunez & Indira Moreno, 2014. "Cost-Effectiveness of Improving Health Care to People with HIV in Nicaragua," Nursing Research and Practice, Hindawi, vol. 2014, pages 1-6, May.
    • Handle: RePEc:hin:jnlnrp:232046
    DOI: 10.1155/2014/232046
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    References listed on IDEAS

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    1. Gregory S. Zaric & Ahmed M. Bayoumi & Margaret L. Brandeau & Douglas K. Owens, 2008. "The Cost-Effectiveness of Counseling Strategies to Improve Adherence to Highly Active Antiretroviral Therapy among Men Who Have Sex with Men," Medical Decision Making, , vol. 28(3), pages 359-376, May.
    2. Elliot Marseille & James Kahn & Christian Pitter & Rebecca Bunnell & William Epalatai & Emmanuel Jawe & Willy Were & Jonathan Mermin, 2009. "The cost effectiveness of home-based provision of antiretroviral therapy in rural Uganda," Applied Health Economics and Health Policy, Springer, vol. 7(4), pages 229-243, December.
    3. Serena P Koenig & Heejung Bang & Patrice Severe & Marc Antoine Jean Juste & Alex Ambroise & Alison Edwards & Jessica Hippolyte & Daniel W Fitzgerald & Jolion McGreevy & Cynthia Riviere & Serge Marceli, 2011. "Cost-Effectiveness of Early Versus Standard Antiretroviral Therapy in HIV-Infected Adults in Haiti," PLOS Medicine, Public Library of Science, vol. 8(9), pages 1-11, September.
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    Cited by:

    1. Hubert Barennes & Amphonexay Frichittavong & Marissa Gripenberg & Paulin Koffi, 2015. "Evidence of High Out of Pocket Spending for HIV Care Leading to Catastrophic Expenditure for Affected Patients in Lao People's Democratic Republic," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-20, September.

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