Milken Institute School of Public Health Poster Presentations (Marvin Center & Video)

Are Patient Retention Efforts Cost-Effective?: A Cost Analysis of a Retention Intervention for HIV Patients at United Medical Center

Poster Number

79

Document Type

Poster

Keywords

HIV; retention in care; cost-effectiveness; micro-costing, costing study; COPC.

Publication Date

3-2016

Abstract

Are Patient Retention Efforts Cost-Effective?: A Cost Analysis of a Retention Intervention for HIV Patients at United Medical Center

Alfred A. Larbi *†$§||‡Ϯ¥∞Ж



Background: Washington, District of Columbia (D.C.) boasts among the highest prevalence of HIV in the U.S., with an epidemic on par with some developing countries. The prevalence of HIV is highest (3.1%) within Ward 8 of D.C., which is the primary service area of the Infectious Disease Care Center (IDC) of United Medical Center (UMC). Linking the high prevalence rate to a low rate of patient retention, the IDC has over a 12-month period, invested $73,586 into operationalizing a HIV-patient retention protocol. The protocol serves as a framework by which the IDC may lower the cost of retention, increase the rate of retention, and ultimately make retention more cost-effective. Retention promotes antiretroviral therapy, sustains viral load suppression, and reduces the incidence of HIV transmission. The results of this retrospective, facility-based, costing study is intended to incentivize policy makers, with the ability to optimize the HIV treatment cascade, to facilitate an improvement in retention rates through structural reform.



Methods: Micro-costing direct methods are applied to measure the impact of enhanced provider contact with patients across time. The methods account for all fixed and variable labor and non-labor costs, and require the units of analysis to be individualized in panel or time series. Sensitivity analysis was performed on each distinct baseline cost variable, to determine the association between cost and enhanced patient-provider contact. Expenditure and outcomes data inform multiple Return on Investment (ROI) analyses. ROI was calculated as the intervention benefit or deficit (the averted or incurred sum of fixed and variable costs associated with the intervention) divided by the intervention cost. In compliance with HAHSTA performance measures, retention is defined as at least one medical visit in each 6-month period of the 24-month measurement period with a minimum of 60 days between medical visits.



Results: The intervention did not improve the visit constancy of the historically retained patients, however it did generate a positive ROI (1%) per additional patient retained in care. The 1% ROI was calculated by dividing the marginal benefit of additional patient retention ($48) by the marginal cost of an additional patient retained in care beyond the pre-intervention period ($4,906). Accounting only for patients that were historically retained, the rate of retention fell from 149 (78.8%) during the pre-intervention period, to 134 (70.9%) during the intervention period. However, of the 31 patients newly enrolled during the pre-intervention period, the intervention achieved an unprecedented 96.8% rate of visit constancy, and also lowered per patient cost of retention by over 50% from $4,954 to $2,374.



Conclusion: The model used to determine cost savings assumes that the units of analysis were individualized in panel or time series. It also assumes that because analyses occurred in a single fiscal year (FY2015) it was unnecessary to account for inflation or discount rates, respectively of previous or subsequent years. Analyses provided an estimated cost of a clinic-based retention in care intervention. The results reveal the intervention is cost-effective. The results also provide useful information for guiding decisions about planning or scaling-up HIV retention interventions.

From the Infectious Disease Care Center (IDC) of United Medical Center (UMC), Washington, DC;

Supported by the Milken Institute School of Public Health of the George Washington University (GWU).

To be presented as an oral presentation at the Milken Institute School of Public Health’s Community Oriented Primary Care Culminating Experience Presentation Series and at the GWU Research Day.

The findings and conclusions in this report are those of the author and do not necessarily represent the views of the GWU, UMC or PAH.

Copyright © 2016 GWU. All rights reserved.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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Are Patient Retention Efforts Cost-Effective?: A Cost Analysis of a Retention Intervention for HIV Patients at United Medical Center

Are Patient Retention Efforts Cost-Effective?: A Cost Analysis of a Retention Intervention for HIV Patients at United Medical Center

Alfred A. Larbi *†$§||‡Ϯ¥∞Ж



Background: Washington, District of Columbia (D.C.) boasts among the highest prevalence of HIV in the U.S., with an epidemic on par with some developing countries. The prevalence of HIV is highest (3.1%) within Ward 8 of D.C., which is the primary service area of the Infectious Disease Care Center (IDC) of United Medical Center (UMC). Linking the high prevalence rate to a low rate of patient retention, the IDC has over a 12-month period, invested $73,586 into operationalizing a HIV-patient retention protocol. The protocol serves as a framework by which the IDC may lower the cost of retention, increase the rate of retention, and ultimately make retention more cost-effective. Retention promotes antiretroviral therapy, sustains viral load suppression, and reduces the incidence of HIV transmission. The results of this retrospective, facility-based, costing study is intended to incentivize policy makers, with the ability to optimize the HIV treatment cascade, to facilitate an improvement in retention rates through structural reform.



Methods: Micro-costing direct methods are applied to measure the impact of enhanced provider contact with patients across time. The methods account for all fixed and variable labor and non-labor costs, and require the units of analysis to be individualized in panel or time series. Sensitivity analysis was performed on each distinct baseline cost variable, to determine the association between cost and enhanced patient-provider contact. Expenditure and outcomes data inform multiple Return on Investment (ROI) analyses. ROI was calculated as the intervention benefit or deficit (the averted or incurred sum of fixed and variable costs associated with the intervention) divided by the intervention cost. In compliance with HAHSTA performance measures, retention is defined as at least one medical visit in each 6-month period of the 24-month measurement period with a minimum of 60 days between medical visits.



Results: The intervention did not improve the visit constancy of the historically retained patients, however it did generate a positive ROI (1%) per additional patient retained in care. The 1% ROI was calculated by dividing the marginal benefit of additional patient retention ($48) by the marginal cost of an additional patient retained in care beyond the pre-intervention period ($4,906). Accounting only for patients that were historically retained, the rate of retention fell from 149 (78.8%) during the pre-intervention period, to 134 (70.9%) during the intervention period. However, of the 31 patients newly enrolled during the pre-intervention period, the intervention achieved an unprecedented 96.8% rate of visit constancy, and also lowered per patient cost of retention by over 50% from $4,954 to $2,374.



Conclusion: The model used to determine cost savings assumes that the units of analysis were individualized in panel or time series. It also assumes that because analyses occurred in a single fiscal year (FY2015) it was unnecessary to account for inflation or discount rates, respectively of previous or subsequent years. Analyses provided an estimated cost of a clinic-based retention in care intervention. The results reveal the intervention is cost-effective. The results also provide useful information for guiding decisions about planning or scaling-up HIV retention interventions.

From the Infectious Disease Care Center (IDC) of United Medical Center (UMC), Washington, DC;

Supported by the Milken Institute School of Public Health of the George Washington University (GWU).

To be presented as an oral presentation at the Milken Institute School of Public Health’s Community Oriented Primary Care Culminating Experience Presentation Series and at the GWU Research Day.

The findings and conclusions in this report are those of the author and do not necessarily represent the views of the GWU, UMC or PAH.

Copyright © 2016 GWU. All rights reserved.