Economic burden of HIV and TB/HIV coinfection in a middle-income country: a costing analysis alongside a pragmatic clinical trial in Brazil

Sex Transm Infect. 2018 Sep;94(6):463-469. doi: 10.1136/sextrans-2017-053277. Epub 2018 Mar 15.

Abstract

Objective: The objective of this study was to measure the costs of people living with HIV (PLHIV) as well as active tuberculosis (TB/HIV), latent tuberculosis infection (LTBI/HIV) or without TB (HIV/AIDS).

Methods: We analysed the costs through the entire pathway of care during the prediagnosis and treatment periods from the Brazilian public health system perspective. We applied a combination of bottom-up and top-down approaches to capture and estimate direct medical and non-medical costs. We measured the mean cost per patient per type of care (inpatient, outpatient and emergency care) and disease category (HIV/AIDS, HIV/AIDS death, TB/HIV, TB/HIV death and LTBI/HIV).

Results: Between March 2014 and March 2016 we recruited 239 PLHIV. During the follow-up 26 patients were diagnosed and treated for TB and 5 received chemoprophylaxis for LTBI. During the prediagnosis and treatment period, the mean total costs for HIV or AIDS and AIDS death categories were US$1558 and US$2828, respectively. The mean total costs for TB/HIV and TB/HIV death categories were US$5289.0 and US$8281, respectively. The mean total cost for the LTBI/HIV category was US$882.

Conclusions: Patients with TB/HIV impose a higher economic burden on the health system than HIV/AIDS and LTBI/HIV. Patients with LTBI/HIV were the lowest cost group among all disease categories, indicating that preventive TB treatment can avoid the further costs treating active TB.

Trial registration number: RBR-22t943, Results.

Keywords: aids; economic analysis; tuberculosis.

Publication types

  • Pragmatic Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brazil / epidemiology
  • Coinfection / economics*
  • Coinfection / epidemiology
  • Cost of Illness
  • Costs and Cost Analysis
  • Female
  • HIV Infections / economics*
  • HIV Infections / epidemiology
  • Health Services Research
  • Humans
  • Income
  • Latent Tuberculosis / economics*
  • Latent Tuberculosis / epidemiology
  • Male
  • Mass Screening
  • Middle Aged
  • Young Adult