The cost of HIV medication adherence support interventions: Results of a cross-site evaluation

Abstract

The objective of this study was to determine the direct cost of HIV adherence support programmes participating in a cross-site evaluation in the US. Data on the frequency, type, and setting of adherence encounters; providers’ professions; and adherence tools provided were collected for 1,122 patients enrolled in 13 interventions at 9 sites. The site staff estimated the average duration of each type of encounter and national wage rates were used for labour costs. The median (range) adherence encounters/year among interventions was 16.5 (4.3–104.6) per patient; encounters lasted 24.6 (8.9–40.9) minutes. Intervention direct cost was correlated with the average frequency of encounters (r = 0.57), but not with encounter duration or providers’ professions. The median direct cost/month was $35 ($5–$58) per patient, and included direct provider costs (66%); incentives (17%); reminders and other tools (8%); and direct administrative time, provider transportation, training, and home delivery (9%). The median direct cost/month from a societal perspective, which includes patient time and travel costs, was $47 ($24–$114) per patient. Adherence interventions with moderate efficacy costing ≤$100/month have been estimated to meet a cost-effectiveness threshold that is generally accepted in the US. Payers should consider enhanced reimbursement for adherence support services.

Acknowledgments

The authors thank Theresa Cassidy, MPH and the site program coordinators for their assistance, and the patients and providers for their participation in the study. This research was supported by funds from the Health Resources and Services Administration, HIV AIDS Bureau, Special Projects of National Significance, Grant #6 H97 HA 00128-03 05, CFDA #93.928.

Additional information

Notes on contributors

CENTER FOR ADHERENCE SUPPORT AND EVALUATION (CASE) TEAM

participating sites (principal investigators): Action Point, San Francisco, CA (D. Ciccarone), Health Services Center, Hobson City, AL (B.S. Hanna), Chase-Brexton Health Center, Baltimore, MD (E. Ritchie), Dimock Community Health Center, Boston, MA (L.R. Hirschhorn), Harlem Hospital Center, New York, NY (S. Mannheimer), Johns Hopkins University School of Medicine, Baltimore, MD (R.D. Moore), Mailman School of Public Health/Columbia University, NY (N. Van Devanter), Mission Neighborhood Health Center, San Francisco, CA (R. Alavarez), Multnomah County Health Department, Portland, OR (J. Dougherty), New York State AIDS Institute, Albany, NY (B. Agins), North Broward Hospital District, Fort Lauderdale, FL (G.S. Bowen), Helena Hatch Special Care Center, Washington University School of Medicine, St. Louis, MO (L.M. Mundy), State University of New York/Downstate Medical Center, Brooklyn, NY (T. Wilson)