Layering and scaling up chronic non-communicable disease care on existing HIV care systems and acute care settings in Kenya: a cost and budget impact analysis.

Brianna Osetinsky,Omar Galárraga,Kimutai Rono,Jeremiah Laktabai,Joan Kimetto,Sonak Pastakia,Ann Mwangi,Marta Wilson-Barthes

doi:10.1002/jia2.25496

Abstract

IntroductionLike many countries in sub‐Saharan Africa, Kenya is experiencing a rapid rise in the burden of non‐communicable diseases (NCDs): NCDs now contribute to over 50% of inpatient admissions and 40% of hospital deaths in the country. The Academic Model Providing Access to Healthcare (AMPATH) Chronic Disease Management (CDM) programme builds on lessons and capacity of HIV care to deliver chronic NCD care layered into both HIV and primary care platforms to over 24,000 patients across 69 health facilities in western Kenya. We conducted a cost and budget impact analysis of scaling up the AMPATH CDM programme in western Kenya using the International Society for Pharmacoeconomics and Outcomes Research guidelines.MethodsCosts of the CDM programme for the health system were measured retrospectively for 69 AMPATH clinics from 2014 to 2018 using programmatic records and clinic schedules to assign per clinic monthly costs. We quantified the additional costs to provide NCD care above those associated with existing HIV or acute care services, including clinician, staff, training, travel and equipment costs, but do not include drugs or consumables as they would be paid by the patient. We projected the budget impact of increasing CDM coverage to 50% of the eligible population from 2021 to 2025, and compared it with the county budgets from 2019.ResultsThe per visit cost of providing CDM care was $10.42 (SD $2.26), with costs at facilities added to HIV clinics $1.00 (95% CI: −$2:11 to $0.11) lower than at primary care facilities. The budget impact of adding 26,765 patients from 2021 to 2025 to the CDM programme was 3,088,928 under constant percent growth, and 3,451,732 under steady‐state enrolment. Scaling up under the constant percent growth scenario resulted in 12% cost savings in the budget impact. The county programmatic CDM cost in 2025 was <1% of the county healthcare budgets from 2019.ConclusionsThe budget impact of scaling up AMPATH’s CDM programme will be driven by annual growth scenarios, and facility/provider mix. By leveraging task shifting, referral systems and partnering with public and non‐profit clinics without NCD services, AMPATH’s CDM programme can provide critical NCD care to new, rural populations with minimal financial impact.

Highlights

Like many countries in sub-Saharan Africa, Kenya is experiencing a rapid rise in the burden of non-communicable diseases (NCDs): NCDs contribute to over 50% of inpatient admissions and 40% of hospital deaths in the country
In addition to better coordinating treatment for NCD/HIV comorbidities associated with ageing, this strategy leverages the advancements in health systems infrastructure, training, and workforce taskshifting developed for HIV care platforms to address the systemic deficits in chronic disease care [9]
Because the costing is reflective of a dynamic treatment program that is adaptive to patient demand and programme capacity, the number of facilities and cost of each varies throughout the period of study

Summary

Introduction

Like many countries in sub-Saharan Africa, Kenya is experiencing a rapid rise in the burden of non-communicable diseases (NCDs): NCDs contribute to over 50% of inpatient admissions and 40% of hospital deaths in the country. The prevalence of NCDs is rising among the HIV infected population, increasing mortality and further complicating chronic disease treatment including adherence to antiretroviral (ART) medications [6,7]. To address this emerging epidemic, the Kenyan Ministry of Health (MOH) developed the National Strategy for the Prevention and Control of Non-Communicable Diseases to implement efficient mobilization and utilization of resources [8]. One of the guiding principles of this strategy is integration of non-communicable disease control into existing primary care and HIV treatment platforms, as NCD care had historically only been available in hospitals.

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