Out-of-pocket costs of AIDS care in China: are free antiretroviral drugs enough?

Figures & data

Table 1. Cost of hospitalization.

Hospital costs	Nanning	Xiangfan
Number of hospitalizations 2005	131	123
Mean cost/hospitalization: US$ (SD)*	1338 (1268)	402 (508)
Mean cost per day of hospitalization: US$ (SD)	64 (179)	30 (23)
Mean length of hospitalization: days (SD)	21 (22)	14 (11)
*SD: standard deviation.

Table 2. Costs of entering free ARV program.

Component	Description	Nanning (US$)	Xiangfan (US$)
ELISA HIV test	Test at VCT (free if patient provides name and identification) or in hospital [hospital cost]	Free or [3.75]	Free or [10]
Western blot	Confirmation HIV test	62.5	Free
Basic lab tests	9 lab tests required by national guidelines	62	22
Transport	Cost for median round-trip to clinic×3 trips	8.75×3 = 26.25	2.5×3 = 7.5
	Total	150.75 US$	29.5 US$

Figure 1.  Cost by component – Nanning.

Figure 2.  Cost by component – Xiangfan.

Table 3. Summary of costs by patient profile.*

	Patient profile	WHO Stage	Nan-ning (%)	Xiang-fan (%)	Description	Year	Nanning (US$)	Xiangfan (US$)
1	Non-ART Good health	I	28 n = 144	22 n = 80	CD4 > 350; HIV Elisa, Western blot, CD4 test each 6 months.	1^st year:	200	12.5
						Following years:	80	5
2	Non-ART Declining health	I	28 n=144	22 n = 80	CD4 250-350; HIV Elisa, Western blot, CD4 test each 3 months.	1^st year:	280	17.5
						Following years:	160	10
3	ART Lower cost	II	13 n = 67	28 n = 101	Starts ART after baseline blood tests; monitoring blood tests; no OI; no hospitalization	1^st year:	359	81
						Following years:	104	27.5
4	ART Lower-middle cost	III	33 n = 170	35 n = 127	Starts ART, necessary blood testing; 2 common and relatively inexpensive OIs; no hospitalization	1^st year:**	395	140
5	ART Upper-middle cost	IV	25 n = 129	15 n = 54	Starts ART; blood testing; 3 common HIV-related conditions, including a costly one requiring a 21-day hospitalization	1^st year:**	1723	746
6	ART High cost	IV	25 n = 129	15 n = 54	Starts ART; blood testing; 3 costliest OIs; above-average hospitalization cost	1^st year:**	3939	1179
7	PMTCT	n/a	n/a	n/a	Starts ART; no OIs; C-section delivery; infant formula	1^st year:**	1498	818
*Approximate costs for first year and subsequent years of HIV care, estimated for various stages of illness. We approximate the proportion of patients that may fall into each category by indicating in columns four and five the percentage of each project's cohort that presented in each WHO stage of illness (column three).
**Since it is unlikely the same OIs would occur year after year, we do not provide an estimate for each additional year's costs for Patients 4,5,6 or 7.

Figure 3.  Costs as percentage of rural and urban annual per capita incomes – Nanning.

Figure 4.  Costs as percentage of rural and urban annual per capita incomes – Xiangfan.

Table 4. Sample costs of first-line ARV regimens (one year, patient > 60kgs).

Triple-combination regimens	Cost/year (US$)
D4T + 3TC + NVP	751
AZT + 3TC + NVP	1240
D4T + 3TC + EFV	1456
AZT + 3TC + EFV	1944
D4T (stavudine, 80mg/day), Chinese generic; AZT (zidovudine, 600mg/day), Chinese generic; 3TC (lamivudine, 300mg/day), Brand-name import; NVP (nevirapine, 400mg/day), Chinese generic; EFV (efavirenz, 600mg/day), Brand-name import.