DOT for HAART
Abstract VIII
 



Edmonton DOT for HAART
Improved Health Care Utilization and Cost Benefits at Multiple Levels with Optimal HIV Treatment Adherence and Efficacy in an Elusive and Vulnerable Inner City Population: Results from the Edmonton DOT for HAART Project
 Peter Akai, Kerry Lavender, Wendi Monahan and Roger Millard

Objective: To describe cost savings at multiple levels with daily directly observed therapy (DOT) for provision of highly active antiretroviral treatment (HAART) to typically non-compliant inner city participants enrolled in the Edmonton DOT for HAART project.

Method: 32 consecutively enrolled HIV positive patients were studied. They were disadvantaged Edmonton inner city residents with disproportionately high aboriginal representation, chaotic lifestyles and a history of homelessness, and high risk behaviours including substance abuse and sex trade. Constructive material and psychosocial supports were provided as daily adherence incentives. Adherence, risk behaviour, HIV disease and health care utilization data were obtained from patient interviews and laboratory and Alberta health care databases. Data comparisons were made before (up to one year) versus after enrolment.

Results: Total project costs were $6,000 per person per year (PPPY). HAART adherence increased to the 90% required for efficacy, and HIV viral load, CD4 lymphocyte counts and risk behaviour scores improved significantly, post-enrolment. Yearly ambulatory care visits and hospital inpatient days significantly decreased from 605 to 420 and from 209 to 85 respectively, before and after enrolment - the estimated average health care utilization cost reduction was $2,254 PPPY.

Conclusion: Adequate adherence ensured effective utilization of a >$10,000 PPPY treatment and minimized HIV drug resistance and inestimable related costs. Decreased HIV viral load, along with risk behaviour reduction, corresponded with an unprecedented fall in local HIV incidence. In addition to major public health implications, separate previous reports have estimated that prevention of each new HIV case saves $12,876 PPPY or over $200,000 in individual lifetime health care costs. These savings, along with those from decreased health care utilization, reflect not only HAART-related decreased morbidity but also improved health care utilization patterns due to program-supported lifestyle stabilization. These outcomes demonstrate cost-effectiveness since DOT for HAART project savings may exceed its costs.