The efficiency of the EmERGE pathway of care for people living with HIV in England

ABSTRACT

This study estimated the efficiency of implementing the EmERGE Pathway of Care for people living with medically stable HIV in Brighton, UK; an App enables individuals to communicate with caregivers via their smart-phone. Individual data on the use of HIV outpatient services were collected one-year pre- and post-implementation of EmERGE. Unit costs of HIV outpatient services were calculated and linked with mean use of services per patient year. Primary outcomes were CD4 count and viral load; patient activation and quality-of-life measures were secondary outcomes. 565 participants were followed up April 2017 - October 2018: 93% men, mean age at recruitment 47.0 years (95%CI:46.2–47.8). Outpatient visits decreased by 9% from 5.6 (95%CI:5.4-5.8) to 5.1 (95%CI:4.9-5.3). Face-to-face visits decreased and virtual visits increased. Annual costs decreased by 9% from £751 (95%CI: £722-£780) to £678 (95%CI: £653-£705). Including anti-retroviral drugs, total annual cost decreased from £7,343 (95%CI: £7,314–7,372) to £7,270 (95%CI: £7,245–7,297): ARVs costs comprised 90%. EmERGE was a cost-saving intervention, patients remained engaged and clinically stable. Annual costs were reduced, but ARVs continue to dominate costs. Extension of EmERGE to other people with chronic conditions, could produce greater efficiencies but these needs to be evaluated and monitored over time.

KEYWORDS:

• PLHIV
• cost & efficiency HIV outpatient services
• mHealth
• EmERGE pathway
• England

Acknowledgements

The authors thank all the participants that took part in this study and the staff that provided support or information, that made the study possible. We also thank the reviewers’ comments that also improved the clarity of the paper.

This study was approved by the South East Coast - Brighton & Sussex Research Ethics Committee.

The dissemination activities within the EmERGE Project do not represent the opinion of the European Community and only reflects the opinion of the authors or the Consortium.

The grant holders developed the study proposal, including EJB & SM. EJB, SM and PY developed and implemented the costing studies, performed the costing analyses, SB and CJ performed the analyses on the secondary outcomes, while JW, JV, DF managed the implementation of the study on site.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The EmERGE project has received funding from the European Union's Horizon 2020 research and innovation programme, PHC-26-2014: Self-management of health and disease: citizen engagement and mHealth under grant agreement No. 643736.