South African Medical Journal

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Cost of a dedicated ART clinic

G Harling, L-G Bekker, R Wood


Background. 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.
Objectives. 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.
Methods. 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).
Results. The total cost of running the site, excluding patientspecific
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%).
Conclusions. 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.

South African Medical Journal Vol. 97 (8) 2007: pp. 593-596

AJOL African Journals Online