A novel Markov model projecting costs and outcomes of providing antiretroviral therapy to public patients in private practices versus public clinics in south Africa

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dc.contributor.authorLeisegang, Roryen_ZA
dc.contributor.authorMaartens, Garyen_ZA
dc.contributor.authorHislop, Michaelen_ZA
dc.contributor.authorSargent, Johnen_ZA
dc.contributor.authorDarkoh, Ernesten_ZA
dc.contributor.authorCleary, Susanen_ZA
dc.date.accessioned2015-11-23T12:36:24Z
dc.date.available2015-11-23T12:36:24Z
dc.date.issued2013en_ZA
dc.description.abstractIntroduction Providing private antiretroviral therapy (ART) care for public sector patients could increase access to ART in low- and middle-income countries. We compared the costs and outcomes of a private-care and a public-care ART program in South Africa. METHODS: A novel Markov model was developed from the public-care program. Patients were first tunneled for 6 months in their baseline CD4 category before being distributed into a dynamic CD4 and viral load model. Patients were allowed to return to ART care from loss to follow up (LTFU). We then populated this modeling framework with estimates derived from the private-care program to externally validate the model. RESULTS: Baseline characteristics were similar in the two programs. Clinic visit utilization was higher and death rates were lower in the first few years on ART in the public-care program. After 10 years on ART we estimated the following outcomes in the public-care and private-care programs respectively: viral load <1000 copies/ml 89% and 84%, CD4 >500 cells/μl 33% and 37%, LTFU 14% and 14%, and death 27% and 32%. Lifetime undiscounted survival estimates were 14.1 (95%CI 13.2-14.9) and (95%CI 12.7-14.5) years with costs of 18,734 (95%CI 12,588-14,022) and 13,062 (95%CI 12,077-14,047) USD in the private-care and public-care programs respectively. When clinic visit utilization in the public-care program was reduced by two thirds after the initial 6 months on ART, which is similar to their current practice, the costs were comparable between the programs. CONCLUSIONS: Using a novel Markov model, we determined that the private-care program had similar outcomes but lower costs than the public-care program, largely due to lower visit frequencies. These findings have important implications for increasing and sustaining coverage of patients in need of ART care in resource-limited settings.en_ZA
dc.identifier.apacitationLeisegang, R., Maartens, G., Hislop, M., Sargent, J., Darkoh, E., & Cleary, S. (2013). A novel Markov model projecting costs and outcomes of providing antiretroviral therapy to public patients in private practices versus public clinics in south Africa. <i>PLoS One</i>, http://hdl.handle.net/11427/15335en_ZA
dc.identifier.chicagocitationLeisegang, Rory, Gary Maartens, Michael Hislop, John Sargent, Ernest Darkoh, and Susan Cleary "A novel Markov model projecting costs and outcomes of providing antiretroviral therapy to public patients in private practices versus public clinics in south Africa." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/15335en_ZA
dc.identifier.citationLeisegang, R., Maartens, G., Hislop, M., Sargent, J., Darkoh, E., & Cleary, S. (2013). A novel Markov model projecting costs and outcomes of providing antiretroviral therapy to public patients in private practices versus public clinics in south Africa. PloS one, 8(2), e53570. doi:10.1371/journal.pone.0053570en_ZA
dc.identifier.ris TY - Journal Article AU - Leisegang, Rory AU - Maartens, Gary AU - Hislop, Michael AU - Sargent, John AU - Darkoh, Ernest AU - Cleary, Susan AB - Introduction Providing private antiretroviral therapy (ART) care for public sector patients could increase access to ART in low- and middle-income countries. We compared the costs and outcomes of a private-care and a public-care ART program in South Africa. METHODS: A novel Markov model was developed from the public-care program. Patients were first tunneled for 6 months in their baseline CD4 category before being distributed into a dynamic CD4 and viral load model. Patients were allowed to return to ART care from loss to follow up (LTFU). We then populated this modeling framework with estimates derived from the private-care program to externally validate the model. RESULTS: Baseline characteristics were similar in the two programs. Clinic visit utilization was higher and death rates were lower in the first few years on ART in the public-care program. After 10 years on ART we estimated the following outcomes in the public-care and private-care programs respectively: viral load <1000 copies/ml 89% and 84%, CD4 >500 cells/μl 33% and 37%, LTFU 14% and 14%, and death 27% and 32%. Lifetime undiscounted survival estimates were 14.1 (95%CI 13.2-14.9) and (95%CI 12.7-14.5) years with costs of 18,734 (95%CI 12,588-14,022) and 13,062 (95%CI 12,077-14,047) USD in the private-care and public-care programs respectively. When clinic visit utilization in the public-care program was reduced by two thirds after the initial 6 months on ART, which is similar to their current practice, the costs were comparable between the programs. CONCLUSIONS: Using a novel Markov model, we determined that the private-care program had similar outcomes but lower costs than the public-care program, largely due to lower visit frequencies. These findings have important implications for increasing and sustaining coverage of patients in need of ART care in resource-limited settings. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0053570 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - A novel Markov model projecting costs and outcomes of providing antiretroviral therapy to public patients in private practices versus public clinics in south Africa TI - A novel Markov model projecting costs and outcomes of providing antiretroviral therapy to public patients in private practices versus public clinics in south Africa UR - http://hdl.handle.net/11427/15335 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15335
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0053570
dc.identifier.vancouvercitationLeisegang R, Maartens G, Hislop M, Sargent J, Darkoh E, Cleary S. A novel Markov model projecting costs and outcomes of providing antiretroviral therapy to public patients in private practices versus public clinics in south Africa. PLoS One. 2013; http://hdl.handle.net/11427/15335.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Clinical Pharmacologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Leisegang et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherMarkov modelsen_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.otherMonte Carlo methoden_ZA
dc.subject.otherToxicityen_ZA
dc.subject.otherViral loaden_ZA
dc.subject.otherDrug therapyen_ZA
dc.subject.otherNursesen_ZA
dc.titleA novel Markov model projecting costs and outcomes of providing antiretroviral therapy to public patients in private practices versus public clinics in south Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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