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Pharmacoeconomic Analysis Of Hiv/Aids Management At Murtala Muhammad Specialist Hospital, Kano, Nigeria

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Pharmacoeconomic Analysis Of Hiv/Aids Management At Murtala Muhammad Specialist Hospital, Kano, Nigeria

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 2010.

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 aboutN3,055 (2.12%) with major contributions from hospitalisation , treatment of co-morbid illnesses and laboratory tests.

6 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.

TABLE OF CONTENTS

Title Page——————————————————————————————-ii
Declaration—————————————————————————————–iii
Certification—————————————————————————————-iv
Acknowledgement———————————————————————————v
Abstract———————————————————————————————vi
Table of Contents——————————————————————————–viii
List of Tables————————————————————————————-xii
List of Figures————————————————————————————xiii
List of Appendices——————————————————————————-xiv
Abbreviations————————————————————————————-xv

CHAPTER ONE: INTRODUCTION
1.1 About this Study——————————————————————————-1
1.2 Statement of Research Problem————————————————————-1
1.3 Justification for the Study——————————————————————–2
1.4 Theoretical Framework———————————————————————–3
1.5Aim and Objective of the Study————————————————————–4
1.6 Statement of Research Hypothesis———————————————————-4

CHAPTER TWO: LITERATURE REVIEW
2.1 Overview of HIV/AIDS———————————————————————-5
2.1.1 HIV/AIDs Timeline————————————————————————-7
2.1.2 Method of Transmission of HIV/AIDS ————————————————12
2.1.3 Impact of HIV/AIDS———————————————————————-14
2.1.4 Factors Militating Against Accessing ART and HIV Care————————–18
2.1.5 HIV Treatment in Nigeria —————————————————————19
2.1.6 Funding for HIV/AIDS——————————————————————-23
2.2 Epidemiology of HIV/AIDS—————————————————————-25
2.2.1 Global Epidemiology of HIV/AIDS—————————————————-25
2.2.2 Epidemiology, Africa———————————————————————27
2.2.3 Epidemiology, Nigeria——————————————————————–28
2.3 Pharmacoeconomics ————————————————————————29
2.3.1 Cost-Effectiveness Analysis————————————————————–30
2.3.2 Cost-Minimization Analysis————————————————————-30
2.3.3 Cost-Benefit Analysis———————————————————————31
2.3.4 Cost-Utility Analysis———————————————————————-31
2.4 Cost of Illness Analysis ——————————————————————–33

CHAPTER THREE: MATERIALS AND METHOD
3.1 Methodology———————————————————————————-35
3.1.1 Study Hospital——————————————————————————35
3.1.2 Study Perspective————————————————————————–35
3.1.3 Study Design——————————————————————————-35
3.1.4 Study Population—————————————————————————35
3.1.5 Study Period——————————————————————————–36
3.1.6 Data Source———————————————————————————36
3.1.7 Sample Size Determination————————————————————–37
3.1.8 Statistical Analysis and Data Presentation———————————————37
3.1.9 Pharmacoeconomic Method————————————————————–38
3.2 Limitation of Study————————————————————————–38

CHAPTER FOUR: RESULTS
4.1 Clinic Population and Clinic Days———————————————————39
4.2 Patients Bio Data —————————————————————————39
4.2.1 Age——————————————————————————————39
4.2.2 Sex——————————————————————————————-39
4.2.3 Education———————————————————————————–41
4.2.4 Marital Status——————————————————————————-41
4.2.5 Education———————————————————————————–41
4.2.6 Income————————————————————————————–41
4.2.7 Household Size—————————————————————————–41
4.2.8 Financial Sponsor————————————————————————–45
4.3 Medical History——————————————————————————45
4.3.1 Diagnostic Tests—————————————————————————45
4.3.2 Treatment Category———————————————————————–45
4.3.3 Co-morbid Illnesses———————————————————————–45
4.3.4 Self-medication—————————————————————————-49
4.3.5 Side Effects/Adverse drug Reaction—————————————————-49
4.3.6 Emergency Room Visits——————————————————————49
4.3.7 Hospitalisation—————————————————————————–49
4.3.8 Alternate Source of Care——————————————————————49
4.4 Costs——————————————————————————————-52
4.4.1 Transport Cost to the Hospital———————————————————–52
4.4.2 Cost Contribution of Health Care Personnel——————————————-52
4.4.3 Cost Contribution of Laboratory Investigations—————————————52
4.4.4 Cost of Drugs——————————————————————————-57
4.4.5 Productivity Losses————————————————————————64
4.4.6 Estimated Contribution of Costs to Health Care Workers and the Patients——–64

CHAPTER FIVE: DISCUSSION
Discussion—————————————————————————————–68
CHAPTER SIX: CONCLUSION
6.1 Summary————————————————————————————–77
6.2 Conclusion————————————————————————————77
6.3 Recommendation—————————————————————————–78
REFERENCES———————————————————————————-79
APPENDICES———————————————————————————–84

 

INTRODUCTION

About the 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 immunodeficiency 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.

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