Cost-effectiveness of an enhanced patient care intervention for improving viral suppression among Kenyan adults living with HIV

Abstract

Objectives: Patient-centered interventions can improve care engagement and treatment adherence for people living with HIV (PLWH). Yet, evidence on their cost-effectiveness remains sparse, hindering their prioritization over alternative models. This study estimated the cost-effectiveness of a patient-centered intervention for improving viral suppression among PLWH in western Kenya. Methods: We analyzed the cost-effectiveness of an enhanced patient-centered (EPC) intervention via a randomized pilot trial among 328 PLWH in 2 rural clinics. The EPC arm included clinician-patient continuity, treatment dialogue, and flexible scheduling. The provider-patient communication (PPC) arm provided training on motivational interviewing. The standard of care arm provided patient-specific interventions to promote viral suppression. Costs were aggregated across the 2 clinics and measured from a societal perspective, including patient time, transportation, and medication. The incremental cost per disability-adjusted life year averted was calculated based on patient virologic failure risk, HIV transmissions averted, and life expectancy. Key parameters were varied by 625% to examine uncertainty in incremental cost- effectiveness ratios. Results: Compared with standard HIV care, both the EPC intervention and PPC training alone were more cost-effective at various willingness-to-pay thresholds. Providing PPC training alone was the dominant strategy (more effective and less costly) compared with the EPC intervention at $97.72 per HIV infection averted and $4.44 per disability-adjusted life year averted. Both interventions were cost savings when factoring in lifetime HIV treatment cost averted. Conclusions: Patient-centered care models may be highly cost-effective for improving treatment outcomes among PLWH. These encouraging results warrant further testing in fully powered clinical trials.