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Treatment for stable HIV patients in England...

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Mark Platt
Member
Posts: 290
Treatment for stable HIV patients in England...
Posted on: June 24 2014, 09:30 am

Just come across this...

Treatment for stable HIV patients in England: can we increase efficiency and improve patient care?

Abstract

Objectives To estimate the costs and potential efficiency gains of changing the frequency of clinic appointments and drug dispensing arrangements for stable HIV patients compared to the costs of hospital pharmacy dispensing and home delivery.
Methods We estimated the annual costs per patient (HIV clinic visits and either first-line treatment or a common second-line regimen, with some patients switching to a second-line regimen during the year). The cost of three-, four- and six-monthly clinic appointments and drug supply was estimated assuming hospital dispensing (incurring value-added tax) and home delivery. Three-monthly appointments and hospital drug dispensing (baseline) were compared to other strategies.
Results The baseline was the most costly option (10,587 if first-line treatment and no switch to second-line regimen). Moving to six-monthly appointments and home delivery yielded savings of 1883 per patient annually. Assuming patients start on different regimens and may switch to second-line therapies, six-monthly appointments and three-monthly home delivery of drugs is the least expensive option and could result in nearly 2000 savings per patient. This translates to annual cost reduction of about 8 million for the estimated 4000 eligible patients not currently on home delivery in London, England.
Conclusions Different appointment schedules and drug supply options should be considered for stable HIV patients based on efficiency gains. However, this should be assessed for individual patients to meet their needs, especially around adherence and patient support.
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Robert James
Member
Posts: 124
Re: Treatment for stable HIV patients in England...
Reply #1 on: June 24 2014, 12:44 pm

Thanks for this Mark

There seem quite a lot of guesses in this model to come up with the 8 million figure (number of people on treatment, number of people stable, number of people currently on home delivery, number of people that could have home delivery).  I have no complaints with the paper itself and the evidence saying 6 monthly appointments and 3 monthly home delivery work out cheaper than 3 monthly appointments and 3 monthly delivery (or 6 monthly appts and 6 monthly delivery) but the 8 million feels like a headline grabber not a real number.  Would have been nice if they had looked at annual appointments and 3 monthly delivery as well but perhaps they were not confident enough of the safety of annual appointments.

In the article it also is much clearer that they are not wanting to force everyone to six monthly appointments and have home delivery of HIV meds who is stable as the abstract implies. They are suggesting however that 80% of people stable on treatment should be on home delivery and seen six monthly although they don't actually put that figure in or provide any evidence why it is the right number or if it is achievable.  They also say that older people with HIV may need to have 3 monthly appointments and without saying what age is 'older' or how that increasing number would reduce this 'saving' in the future.
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Rupert Whitaker
Member
Posts: 42
Re: Treatment for stable HIV patients in England...
Reply #2 on: August 12 2014, 01:35 pm

I see a lot on efficiency and financial cost-saving and not much on improving "care" (whatever that means - does it mean health-outcomes, service-outputs, or ?). An interesting article to read; thanks, Mark.
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John Holland
Member
Posts: 21
Re: Treatment for stable HIV patients in England...
Reply #3 on: August 13 2014, 12:01 pm

All of the supposed savings derive from VAT savings due to the home delivery system.

The Home Delivery system is in melt-down.

There is no legal basis for charging VAT on these medicines when dispensed at the clinic.  On checking it appears that, as required under a European directive (Council Directive 2006/112/EC of 28 November 2006 on the common system of value added tax), ALL prescription medications have a VAT rate of 0%.  Medical care is exempt from VAT.

Someone has some explaining to do.

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