Drug cost implications of treating HIV/ AIDS patients with mental illness at Muhimbili national hospital, Tanzania

Abstract

Background Tanzanian patients suffering with HIV/AIDS or mental illness are treated free of charge as per the Ministry of Health and Social welfare (MOHSW) cost sharing policy of 1993. The exemption of cost sharing for HIV/AIDS patients put a severe financial burden on the government to provide free treatment and care to an estimated 1.8 million patients. Although there are many checks and balances to quantify the national drug use and expenditure of antiretroviral (ARV) and TB drugs; there is no parallel system of quantifying the expenditure associated with the other drugs used to manage HIV related co morbidities such as mental illness which is also exempted. Objective The study was conducted to determine drug cost implications associated with the treatment of HIV patients with mental illness as compared to those with HIV alone. Methodology Prescription data was retrieved from the MNH JEEVA electronic data base for all the attendees of MHN HIV Clinic from January 2008 to December 2010.The drug cost prices were obtained from the Medical Store Department (MSD) and the July 2010 government subsidised price list was used. One United States dollar (US$) was set to be equivalent to 1,600 Tsh. Retrieved Data was exported into Excel and data analysed using SPSS and R- Statistical Computing Software. Results A total of 1913 out of 1987 (96.7%) patient’s data were analyzed. The majority of the clinic attendees were from Kinondoni district Dar es Salaam (51.2%). The mean age for the patient was 43.2 (range 18-85 years). The majority of patients were female and married, 69.7% and 51.3%, respectively. First visit to emergency medicine and psychiatry departments contributed 41% and 25% respectively of previously undiagnosed HIV infected persons. The total drug cost for the study period was US$ 906,450.5 (Tsh1, 450,320,800). The average drug expenditure cost per person per year(PPY) was US$ 204. 1 (Tsh 326,540.7). The majority of patients were on first line ARV regimens (98.4%) and the total cost for antiretrovirals (ARVs) was US$ 804,449.5 (Tsh 1,287,119,205). The cost for PPY for patients on ARV alone was US$ 197.0 (Tsh 315,261.9). The total cost for mental illness drugs for the study period was US$ 6,943.5 (Tsh 11,109,629) with Amitriptyline being the most commonly prescribed mental illness drug at 55.9%. The proportion of attendees that were prescribed drugs for the management of mental illness in the study period was 16.5%, with 8.5% of these being for the management of severe mental illness. Patients with HIV and mental illness had a significantly higher mean drug expenditure cost per person years of US$ 278. 6 (Tsh 445,717.5), compared with patients with HIV alone whose mean cost was US$ 226. 7 (Tsh 362,664.6/=) [p-value <0.0001]. There was no significant difference in the number of HIV patients with mental illness on first line ARV regimens compared to second line regimens. Switching HIV/ mental illness patients onto second line ARV regimens significantly increased the drug cost per person years from US$ 198.5 to US$ 1,108.0 (Tsh 317,657.8 to 1,772,801.6 [p-value <0.0001]. Conclusions and Recommendation Mental illness develops in a significant proportion of HIV patients at MNH. Drugs used to manage co- morbid HIV/mentally ill patients have a significant impact on the cost of treating these patients, making this group of HIV patients a more expensive group with respect to drug costs. The high contribution of first case psychiatry presentation in identifying HIV infected persons strongly advocates that psychiatric care should be part and parcel of routine HIV care and treatment programs at Muhimbili National Hospital (MNH).