Pharmacoeconomic Analysis Of HIV / AIDS Management Pharmacy

Project and Seminar Material for Pharmaceutical Science

Pharmacoeconomic Analysis Of HIV / AIDS Management Pharmacy


Abstract


The HIV/AIDS pandemic has resulted in mortality surge and life expectancy drop throughout the world. Developing countries are mostly affected due to their limited health care system and resources to handle the increasing costs of management of HIV/AIDS and associated opportunistic infections. The objective of this study is to estimate direct and indirect costs of managing HIV/AIDS to both the health sector and the patients, at Murtala Muhammad Specialist Hospital, Kano (MMSH). Patients‘ data from a sample of 256 adults and 28 children were collected between 1st January and 31st December 2020. The study revealed that majority of the patients were aged between 15 and 49 (87.7%), female (66.2%) and married (71.48%), while about forty percent were unemployed (39.8%) and 27.1% had an income of less N20,000. The average annual income for the patients was estimated to be N143,796. About half of the respondents had a CD4 count test done once (52.5%), most were on antiretrovirals (94.37%), a few had co-morbid illnesses (12.32%), side effects/adverse drug reactions (10.9%), hospitalized (11.27%) or had National Health Insurance Scheme (NHIS) coverage(3.87%). The estimated average total annual costs to the health sector and patients were N323,303 and N10,516 respectively. Major contributors to health sector costs which were all direct-medical costs were antiretroviral drugs (83.60%) and health care personnel (12.37%). Direct-medical costs to patients amounted to about N3,055 (2.12%) with major contributions from hospitalisation, treatment of co-morbid illnesses and laboratory tests. Direct non-medical and indirect costs to patients were derived from transport (N2,634, 1.83%) and productivity loss (N4,827; 3.36%) respectively, the total patients cost of N10,516 amounted to 7.31% of their average annual income of N143,796. Thus, data obtained suggested that the management of HIV/AIDS at MMSH poses a serious economic burden on the health care system and on patients living with the disease. Majority of the health care costs (antiretrovirals) were provided by Non Governmental Organisations (NGOs); this scenario applies all over the country. In the event that the NGOs withdraw their aid in the future, the burden to the health sector may be too much for the Government to bear. The expansion of the NHIS to include HIV/AIDS management will decrease the burden on the Government and the patients. Increasing efforts on HIV infection prevention should also significantly decrease the burden of HIV/AIDS in the long run.


Chapter One


Introduction

1.1 Background of Study

Ill-health can result in an increase in economic burden on individuals, contributing to income loss, asset depletion as well as investment of a large amount of National resources to combating that disease. These processes are brought into sharper focus by the social and economic impact of the human immunodeficiency virus/acquired immuno deficiency syndrome (HIV/AIDS)epidemic. Concern about the links between ill-health and impoverishment has placed health at the centre of development agencies‘ poverty reduction targets and strategies. This has strengthened arguments for a substantial increase in health sector investment to improve access for the world‘s poorest people to combat poverty as well as reduce disease burden (Russel, 2004). This thesis reports on an evaluation of costs committed to HIV/AIDS management in a secondary health facility, (MMSH) in Kano, Nigeria.


1.2 Statement of Research Problem

The HIV/AIDS pandemic constitutes one of the greatest health challenges of our time (IBBSS, 2008) and its impact cannot be overemphasized. HIV has added to the burden of the already over-stretched health care infrastructure in Nigeria as well as increased the number of orphans and other vulnerable children, placing additional strain on family and community support structures (FMOH, 2008).

With the growth rate (2%) and burden of illness, it is important for us to know the impact of HIV/AIDS management on health systems, individuals and societies as well as a description and analysis – a measure of the cost of illness (COI), which is a major tool in pharmacoeonomics. According to CDC (2009), COI is defined as the value of the resources that are expended or foregone as a result of a health problem. The COI includes health sector costs, the value of lost productivity by the patient (indirect cost), and the cost of pain and suffering (intangible costs) (CDC, 2009).


1.3 Aim and Objective of the Study

1.3.1 Aim of the Study

The aim of this study is to determine the economic burden of management of HIV/AIDS patients at the Murtala Mohammed Specialist Hospital Kano, Nigeria.

1.3.2 Specific Objectives of the Study
  1. To determine the direct and indirect components of COI of HIV/AIDS on the health caresector
  2. To determine the direct and indirect components of the COI of HIV/AIDS of patients.

1.4 Research Question

What economic burden does management of HIV/AIDS at the Murtala Mohammed Specialist Hospital, Kano, have on the health care system and on the patients.


1.5 Justification for the Study

Poverty, an issue in Sub-Saharan Africa, exacerbates the impact of HIV and AIDS. Food insecurity also weakens the beneficial effects of medicine, while caring for the sick and those orphaned or widowed by AIDS stretches families’ resources to their limits. HIV/AIDS continues to devastate the African region, which has 11% of the world’s population, but 60% of the people with HIV/AIDS. Although HIV/AIDS remains the leading cause of death for adults, more and more people are receiving life- saving treatment. The number of HIV-positive people on antiretroviral medicines increased eight-fold, from 100 000 in December 2003 to 810 000 in December 2005 (WHO, 2009). These epidemiological data help determine a nation‘s current health profile and systems and also identify the effectiveness of available technologies in eliminating these problems.

The African Regional Health Report (2009), stresses that Africa can move forward on recent progress only by strengthening its fragile health systems. To achieve this, it would need to make informed choices on which health problems to address and what interventions to use to alleviate them hence, knowledge of the economic burdens of the various health problems is important. A major drawback to carrying out these evaluations in Africa is the already limited resources to the health sector.


Chapter Five


Conclusion and Recommendation

5.1 Conclusion

HIV/AIDS management is expensive both to the provider and to the patient. The NGOs have not been able to reach their targets of having all HIV positive eligible patients on therapy and the Government of Nigeria should think of putting in funds to augment the efforts of the donors.

More awareness on prevention may be a cheaper stance for the Government to take so as to decrease overall burden of the disease.


5.2 Recommendations

Hastening expansion of HIV/AIDS treatment, prevention and care by decentralization of services and moving them to primary facilities as well as communities may be the key to decreasing overall disease burden in the long run.

This will improve awareness on HIV/AIDS in all nook and crannies thereby decreasing incidence of new infections as well as decrease costs such as transport, indirect costs like hospital waiting time, absenteeism from work (because of less patients) and improvement in patient care as the number of patients per clinic day would be decreased. This may also decrease the incidences of OIs andself-medication.

A need for the full documentation of all visits and consultations would ease further studies as well as improve study outcome.

Consolidation of healthcare could be done; this could be by improving on the NHIS or alternative health insurance packages and expanding it to include HIV/AIDS management and redesigning the scheme such that both blue collar and white collar workers benefit from the scheme.


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