ABSTRACT
The HIV/AIDS pandemic has resulted in mortality surge and life
expectancy drop throughout the world. Developing countries are mostly
affected due to their limited health care system and resources to handle
the increasing costs of management of HIV/AIDS and associated
opportunistic infections. The objective of this study is to estimate
direct and indirect costs of managing HIV/AIDS to both the health sector
and the patients, at Murtala Muhammad Specialist Hospital, Kano (MMSH).
Patients‘ data from a sample of 256 adults and 28 children were
collected between 1st January and 31st December 2010. The study revealed
that majority of the patients were aged between 15 and 49 (87.7%),
female (66.2%) and married (71.48%), while about forty percent were
unemployed (39.8%) and 27.1% had an income of less N20,000. The average
annual income for the patients was estimated to be N143,796. About half
of the respondents had a CD4 count test done once (52.5%), most were on
antiretrovirals (94.37%), a few had co-morbid illnesses (12.32%), side
effects/adverse drug reactions (10.9%), hospitalized (11.27%) or had
National Health Insurance Scheme (NHIS) coverage(3.87%). The estimated
average total annual costs to the health sector and patients were
N323,303 and N10,516 respectively. Major contributors to health sector
costs which were all direct-medical costs were antiretroviral drugs
(83.60%) and health care personnel (12.37%). Direct-medical costs to
patients amounted to about N3,055 (2.12%) with major contributions from
hospitalisation , treatment of co-morbid illnesses and laboratory
tests. Direct non-medical and indirect costs to patients were derived
from transport (N2,634, 1.83%) and productivity loss (N4,827; 3.36%)
respectively, the total patients cost of N10,516 amounted to 7.31% of
their average annual income of N143,796. Thus, data obtained suggested
that the management of HIV/AIDS at MMSH poses a serious economic burden
on the health care system and on patients living with the disease.
Majority of the health care costs (antiretrovirals) were provided by Non
Governmental Organisations (NGOs); this scenario applies all over the
country. In the event that the NGOs withdraw their aid in the future,
the burden to the health sector may be too much for the Government to
bear. The expansion of the NHIS to include HIV/AIDS management will
decrease the burden on the Government and the patients. Increasing
efforts on HIV infection prevention should also significantly decrease
the burden of HIV/AIDS in the long run.
Introduction
Ill-health can result in an increase in economic burden on
individuals, contributing to income loss, asset depletion as well as
investment of a large amount of National resources to combating that
disease. These processes are brought into sharper focus by the social
and economic impact of the human immunodeficiency virus/acquired
immunodeficiency syndrome (HIV/AIDS) epidemic. Concern about the links
between ill-health and impoverishment has placed health at the centre of
development agencies‘ poverty reduction targets and strategies. This
has strengthened arguments for a substantial increase in health sector
investment to improve access for the world‘s poorest people to combat
poverty as well as reduce disease burden (Russel, 2004). This thesis
reports on an evaluation of costs committed to HIV/AIDS management in a
secondary health facility, (MMSH) in Kano, Nigeria.
1.2 Statement of Research Problem
The HIV/AIDS pandemic constitutes one of the greatest health
challenges of our time (IBBSS, 2008) and its impact cannot be
overemphasized. HIV has added to the burden of the already
over-stretched health care infrastructure in Nigeria as well as
increased the number of orphans and other vulnerable children, placing
additional strain on family and community support structures (FMOH,
2008).
With the growth rate (2%) and burden of illness, it is important for
us to know the impact of HIV/AIDS management on health systems,
individuals and societies as well as a description and analysis – a
measure of the cost of illness (COI), which is a major tool in
pharmacoeonomics. According to CDC (2009), COI is defined as the value
of the resources that are expended or foregone as a result of a health
problem. The COI includes health sector costs, the value of lost
productivity by the patient (indirect cost), and the cost of pain and
suffering (intangible costs) (CDC, 2009).