The cost of providing hospital-based (early) antiretroviral treatment in Indonesia: what has changed in almost a decade?

ABSTRACT

17% of all people living with HIV in Indonesia who are in need of antiretroviral treatment (ART) actually receive the treatment. The cost of ART based on three CD4 cell count groups (e.g., 0–200, 201–350, >350 cells/mm³) in a main referral hospital in West Java, Indonesia, in 2011–2016 was compared to the results from a decade earlier in the same setting. Costs were estimated including resources used for opportunistic infection treatment, laboratory tests, and antiretroviral (ARV) drugs. For each group, we divided the costs into several periods: pre-ART, and every 6 months up to 24 months after onset of treatment. Before ART, costs were dominated by laboratory tests (>80%); ARV drugs were the main cost after treatment onset (>92%). Average cost of treatment per year was US$600 across all groups. Moreover, the patient cost to access ART (n = 49 patients) did not exceed 10% of their household monthly expenditures (i.e., 4%). The unit cost of providing ART per patient/year is half the cost under the previous treatment initiation guidelines. A lower ARV drug cost, more patients in higher CD4 cell-count groups, and lower viral load test cost characterize the current cost profile.

KEYWORDS:

• Cost analysis
• antiretroviral therapy
• HIV
• Indonesia

Acknowledgement

The authors thank K Irmawati from Teratai Clinic for providing the necessary data, MN Juwita from Universitas Padjadjaran for her patient cost data collection, and L Bijlmakers from Radboud University and IY Mambea from Universitas Padjadjaran for their valuable input.

Disclosure statement

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

Precis

Provide new ART cost estimation in a hospital setting.

Additional information

Funding

This work was supported by Radboud University Nijmegen (Kostenplaats: 1642; Project: R0002510).