Cost effectiveness of a pharmacy-only refill program in a large urban @entity645 / XXXX clinic in Uganda.

@entity1 @entity404 @entity645 @entity791 @entity166
BACKGROUND: @entity645 / @entity791 clinics in Uganda and other low-income countries face increasing numbers of @entity1 and workforce shortages. We performed a cost-effectiveness analysis comparing a Pharmacy-only Refill Program (PRP), a form of task-shifting, to the Standard of Care (SOC) at a large @entity645 / @entity791 clinic in Uganda, the @entity166 Institute (IDI). The PRP was started to reduce workforce shortages and optimize @entity1 care by substituting pharmacy visits for SOC involving monthly physician visits for accessing antiretroviral medicines. METHODOLOGY/PRINCIPAL FINDINGS: We used a retrospective cohort analysis to compare the effectiveness of the PRP compared to SOC. Effectiveness was defined as Favorable Immune Response (FIR), measured as having a @entity404 lymphocyte count of over 500 cells/  l at follow-up. We used multivariate logistic regression to assess the difference in FIR between @entity1 in the PRP and SOC. We incorporated estimates of effectiveness into an incremental cost-effectiveness analysis performed from a limited societal perspective. We estimated costs from previous studies at IDI and conducted univariate and probabilistic sensitivity analyses. We identified 829 @entity1 , 578 in the PRP and 251 in SOC. After 12.8 months (PRP) and 15.1 months (SOC) of follow-up, 18.9% of @entity1 had a FIR, 18.6% in the PRP and 19.6% in SOC. There was a non-significant 9% decrease in the odds of having a FIR for PRP compared to SOC after adjusting for other variables (OR 0.93, 95% CI 0.55-1.58). The PRP was less costly than the SOC (US  520 vs. 655 annually, respectively). The incremental cost-effectiveness ratio comparing PRP to SOC was US  13,500 per FIR. PRP remained cost-effective at univariate and probabilistic sensitivity analysis. CONCLUSION/SIGNIFICANCE: The PRP is more cost-effective than the standard of care. Similar task-shifting programs might help large @entity645 / @entity791 clinics in Uganda and other low-income countries to cope with increasing numbers of @entity1 seeking care.
