Clinical and Financial Burdens of Secondary Level Care in a Public Sector Antiretroviral Roll-Out Setting: GF Jooste Hospital

Abstract

Background: Antiretroviral therapy is being rolled out across South Africa. While efforts have been made to assess the costs of providing antiretroviral therapy (ART) via accredited service points, little information is available on its downstream costs, particularly in public secondary level hospitals.

Objectives: (1) To determine the cost of care for inpatients and outpatients at a dedicated Antiretroviral Referral Unit treating and caring for antiretroviral-related conditions in a South African peri-urban setting, (2) to identify key epidemiological cost drivers, and (3) to examine the associated clinical and outcome data.

Methods: A prospective costing study on 48 outpatients and 25 inpatients was conducted from a health system perspective. Incremental economic costs and clinical data were collected from primary sources at GF Jooste Hospital, Cape Town, over a one month period (March 2005).

Results: Incremental cost per outpatient was R1280 and per inpatient R5802. Costs were dominated by medical staff costs (62% inpatient and 58% outpatient respectively). Inpatient and outpatient diagnoses and costs were dominated by infections (55% and 67%; 49% and 54% respectively). Most inpatients and outpatients were judged by attending physicians to have improved or stabilized as a result of treatment (52% and 59% respectively).

Conclusions: The costs of providing secondary level care for patients on or immediately preceding ART initiation can be significant and should be included in the government’s strategic planning so that (1) the service can be expanded to meet current and future needs and (2) to avoid crowding out other secondary level health services.