Economic evaluations of HIV treatment and health research with people diagnosed with HIV infection and co-occurring mental health and substance use disorders

Abstract

This paper describes the research challenges involved in measuring costs in economic evaluations of patients who are coping simultaneously with HIV/AIDS and co-occurring mental health and substance abuse disorders—especially in multi-site studies. We describe the general issues that arise in measuring costs for this population and suggest some operational solutions for their resolution, drawing from our experience in a recent multi-site health services research study focused on this population. We show that while reliance on patient self-report data may be unavoidable to provide a common denominator in multi-site studies, there are also some practical ways of improving the accuracy of such data and the cost estimates that result from them. We also provide readers with a means for securing the data collection instruments developed for the cost component of this study in the hope that these may serve as templates for researchers doing similar work.

Acknowledgments

The authors would like to acknowledge other members of the Cost Subcommittee of the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study whose contributions to the conceptualization and instrumentation were critical to the development of this paper. These include Peter Arno, Karen Bonuck, Thomas W. Helminiak, Ali Manwar, Rebecca R. Roberts, Susan Pfoutz, and Dave Thompson.

Notes

The HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study (hereinafter referred to as the HIV/AIDS Cost Study) is the first federally funded multi-agency co-operative multi-site study of integrated interventions for HIV primary care, mental health, and substance abuse. The study involves eight different sites across the country, each of which will be testing a different approach towards treating individuals who are triply diagnosed with HIV, substance abuse, and mental health problems. While each site is evaluating common outcomes, the populations being treated are very different, as are the approaches to improving adherence to treatment. This study is described more completely in the lead article in this issue.

The literature and debate over standard gamble vs. time trade-off are well-summarized in Gold et al. (1996).