Cost of a dedicated ART clinic.

Abstract

The provision of antiretroviral therapy (ART) is being rolled out across South Africa. Little evidence exists on the cost of running clinics for ART provision. To determine the cost per patient-month enrolled in an ART programme and per patient-visit for a dedicated, public-sector ART clinic in a South African peri-urban setting in 2004/05 and 2005/06, as the clinic moved from a temporary to a permanent site. A retrospective costing study was performed from a programme perspective. Two years of expenditure data for the clinic were collected from primary sources. Costs per patient visit and per patient-month were calculated in Rand and converted to 2004 US$ (R6.4347 = US$1). The total cost of running the site, excluding patient-specific items (medicines and medical tests), was $174,072 in 2004/05 and $421,872 in 2005/06. Cost per patient-month fell from $40.29 to $36.47, a 9% decrease; cost per patient-visit fell from $54.79 to $41.62, a 24% decrease. In 2005/06, 68% of all expenditure was on medical and pharmacy staff (versus 62% in 2004/05), 23% was on the employment of peer adherence counsellors (versus 35%), and the remaining 9% was on capital costs and supplies (versus 3%). The increase in scale of operation for the provision of ART at this clinic allowed economies of scale to be reaped. Staff costs, both medical and support, comprised the large majority of total clinic costs, such that the erection of a dedicated building for the clinic had little impact on the economic cost of care.