Provider-initiated HIV counseling and testing of out patients at community hospitals in Thailand: an economic evaluation using the Markov model.
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Date
2010-06
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Abstract
Background: Provider-initiated HIV counseling and testing (PIHIVCT) is an important intervention that improves
the access to care to HIV-infected patients and subsequently contributes to the success of national HIV/AIDS
control efforts. However, in Thailand, the cost-effectiveness of this program is unknown.
Objective: Determine the incremental cost-effectiveness ratios (ICER) in terms of Thai Baht per Quality Adjusted
Life Year (QALY) of PIHIVCT for outpatient department (OPD) patients in community hospitals of Thailand
compared with the current practice.
Methods: A model-based health economic evaluation study was conducted based on results from cluster randomized
controlled trials in 16 community hospitals of Thailand. The Markov model and the probabilistic sensitivity
analysis were used. One-thousand two-hundred seventy-seven HIV-infected patients completed questionnaires
on their household expenditure and quality of life using the visual analog scale.
Results: In social perspectives, the PIHIVCT program increased a patient’s life span by 5.18 days or 4.15 qualityadjusted
days per OPD case and the ICER was 63,588 Baht per QALY gained. The subgroup analysis showed that
the PIHIVCT program would be cost-effective for cases younger than 50 years if the ceiling threshold of willing to
pay equaled the per capita Gross Domestic Product (GDP). However, this intervention would be cost-effective for
all cases of 13-64 year old if the ceiling threshold equaled three times of GDP.
Conclusion: The provider-initiated HIV counseling and testing program for OPD patients is more cost-effective
than the current practice and should be implemented in health care setting in Thailand.
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Keywords
Community hospital, economic evaluation, HIV/AIDS, provider-initiated testing, quality of life, Markov model
Citation
Asian Biomedicine (Research Reviews and News); Vol. 4 No. 3 Jun 2010; 479-484.