Cost Effectiveness of VCT and PITC in a Hospital Based Clinic in Indonesia A Preliminary Results

Background: The HIV epidemic in Indonesia is among the fastest growing in Asia and call for interventions scaling up. Two current adapted interventions are Voluntary Counselling and Testing (VCT) and Provider Initiated Counselling and Testing (PICT). Scaling up these two interventions, however, must be analysed using economic evaluation given the limited existing budget. Two concerns prevail: 1) the economic evaluation studies on both interventions are limited, and 2) there is a question on extending the coverage of VCT through PICT which has not been economically analysed. Methods: The cost estimation is based on a previous study on the costs of delivering VCT which is adapted to estimate the cost of delivering hospital based VCT and PICT. The effectiveness study is also adapted from a previous study on the natural decline of CD 4 cell count on HIV (+) clients for intravenous drug user (IDU) and non IDU, related to the life years gained. Results: Most clients are on their productive age. The unit cost per HIV (+) detected differ by US$37. The time gain of performing VCT compared to PICT for IDU is shorter than that of the non-IDU. The Incremental Cost Effectiveness Ratio (ICER) of performing VCT compared to PICT for unit cost per HIV (+) case is higher for non IDU compared to IDU. Discussion: VCT has the benefit of early detection compared to PICT. The unit costs of VCT and PICT per HIV (+) cases for each service shows higher costs for PICT than VCT. The ICER based on unit costs per HIV (+) case for both IDU and non – IDU shows that providing VCT will result in less cost in gaining more life years. Although the results show that VCT seems to be more cost effective than PICT, the unique characteristics of PICT should also be considered. We recommend that PICT should not be made as the scaling up measure of VCT, but should stay as a complementary.