Impact of the removal of patient co-payments for antiretroviral therapy (ART) on out-of-pocket expenditure, adherence and virological failure among Australian adults living with HIV
•Removal of patient co-payments for ART did not reduce total out-of-pocket healthcare expenditure•Co-payment removal did not improve ART adherence or reduce HIV virological failure•Participants receiving concessional government benefits experienced an increase in HIV related expenditures•Participant...
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Published in | Health policy (Amsterdam) Vol. 125; no. 9; pp. 1131 - 1139 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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Elsevier B.V
01.09.2021
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Abstract | •Removal of patient co-payments for ART did not reduce total out-of-pocket healthcare expenditure•Co-payment removal did not improve ART adherence or reduce HIV virological failure•Participants receiving concessional government benefits experienced an increase in HIV related expenditures•Participants with the lowest income remain vulnerable to the relative high-cost burden of HIV care•Further, larger studies are warranted
: In 2015, New South Wales (Australia) removed patient co-payments for ART of HIV. We hypothesized the policy change would reduce overall out-of-pocket (OOP) healthcare expenditure, improve ART adherence, and better maintain HIV suppression. Methods: Using data from a national, 2-year prospective study of adults with HIV on ART (n=364) (2013-2017), we compared OOP healthcare expenditure, ART adherence, and virological failure (VF) in participants subject to the co-payment policy change with participants from other jurisdictions who never paid, and who always paid, co-payments. We used fixed effects regression models to compare outcomes, and incidence rates for VF.
: Although ART co-payments declined, there was no significant change in total OOP healthcare expenditure in participants ceasing co-payments compared to those who continued (adjusted coefficient 0.09, 95% CI -0.31 to 0.48). Co-payment removal did not significantly reduce suboptimal ART adherence (from 17.5% to 16.3%) or VF (from 5.0 to 3.7 episodes per-100-person-years). Participants in the lowest income group but not receiving concessional government benefits incurred a non-significant increase in total OOP healthcare expenses; while concessional participants experienced a significant increase in non-ART HIV healthcare costs after the policy changed.
: In this population, ART co-payments represented a small proportion of OOP healthcare expenditure. Its removal did not materially impact ART adherence or VF, although the study was not powered to detect these. |
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AbstractList | In 2015, New South Wales (Australia) removed patient co-payments for ART of HIV. We hypothesized the policy change would reduce overall out-of-pocket (OOP) healthcare expenditure, improve ART adherence, and better maintain HIV suppression.
Using data from a national, 2-year prospective study of adults with HIV on ART (n=364) (2013-2017), we compared OOP healthcare expenditure, ART adherence, and virological failure (VF) in participants subject to the co-payment policy change with participants from other jurisdictions who never paid, and who always paid, co-payments. We used fixed effects regression models to compare outcomes, and incidence rates for VF.
Although ART co-payments declined, there was no significant change in total OOP healthcare expenditure in participants ceasing co-payments compared to those who continued (adjusted coefficient 0.09, 95% CI -0.31 to 0.48). Co-payment removal did not significantly reduce suboptimal ART adherence (from 17.5% to 16.3%) or VF (from 5.0 to 3.7 episodes per-100-person-years). Participants in the lowest income group but not receiving concessional government benefits incurred a non-significant increase in total OOP healthcare expenses; while concessional participants experienced a significant increase in non-ART HIV healthcare costs after the policy changed.
In this population, ART co-payments represented a small proportion of OOP healthcare expenditure. Its removal did not materially impact ART adherence or VF, although the study was not powered to detect these. BACKGROUNDIn 2015, New South Wales (Australia) removed patient co-payments for ART of HIV. We hypothesized the policy change would reduce overall out-of-pocket (OOP) healthcare expenditure, improve ART adherence, and better maintain HIV suppression. METHODSUsing data from a national, 2-year prospective study of adults with HIV on ART (n=364) (2013-2017), we compared OOP healthcare expenditure, ART adherence, and virological failure (VF) in participants subject to the co-payment policy change with participants from other jurisdictions who never paid, and who always paid, co-payments. We used fixed effects regression models to compare outcomes, and incidence rates for VF. RESULTSAlthough ART co-payments declined, there was no significant change in total OOP healthcare expenditure in participants ceasing co-payments compared to those who continued (adjusted coefficient 0.09, 95% CI -0.31 to 0.48). Co-payment removal did not significantly reduce suboptimal ART adherence (from 17.5% to 16.3%) or VF (from 5.0 to 3.7 episodes per-100-person-years). Participants in the lowest income group but not receiving concessional government benefits incurred a non-significant increase in total OOP healthcare expenses; while concessional participants experienced a significant increase in non-ART HIV healthcare costs after the policy changed. CONCLUSIONIn this population, ART co-payments represented a small proportion of OOP healthcare expenditure. Its removal did not materially impact ART adherence or VF, although the study was not powered to detect these. •Removal of patient co-payments for ART did not reduce total out-of-pocket healthcare expenditure•Co-payment removal did not improve ART adherence or reduce HIV virological failure•Participants receiving concessional government benefits experienced an increase in HIV related expenditures•Participants with the lowest income remain vulnerable to the relative high-cost burden of HIV care•Further, larger studies are warranted : In 2015, New South Wales (Australia) removed patient co-payments for ART of HIV. We hypothesized the policy change would reduce overall out-of-pocket (OOP) healthcare expenditure, improve ART adherence, and better maintain HIV suppression. Methods: Using data from a national, 2-year prospective study of adults with HIV on ART (n=364) (2013-2017), we compared OOP healthcare expenditure, ART adherence, and virological failure (VF) in participants subject to the co-payment policy change with participants from other jurisdictions who never paid, and who always paid, co-payments. We used fixed effects regression models to compare outcomes, and incidence rates for VF. : Although ART co-payments declined, there was no significant change in total OOP healthcare expenditure in participants ceasing co-payments compared to those who continued (adjusted coefficient 0.09, 95% CI -0.31 to 0.48). Co-payment removal did not significantly reduce suboptimal ART adherence (from 17.5% to 16.3%) or VF (from 5.0 to 3.7 episodes per-100-person-years). Participants in the lowest income group but not receiving concessional government benefits incurred a non-significant increase in total OOP healthcare expenses; while concessional participants experienced a significant increase in non-ART HIV healthcare costs after the policy changed. : In this population, ART co-payments represented a small proportion of OOP healthcare expenditure. Its removal did not materially impact ART adherence or VF, although the study was not powered to detect these. |
Author | Carr, Andrew de Wit, John Mao, Limin Lee, Evelyn Siefried, Krista J Rule, John |
Author_xml | – sequence: 1 givenname: Evelyn surname: Lee fullname: Lee, Evelyn email: evelyn.lee@mq.edu.au organization: Centre for Economic Impacts of Genomic Medicine, Macquarie University, New South Wales, Australia – sequence: 2 givenname: Limin surname: Mao fullname: Mao, Limin organization: Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia – sequence: 3 givenname: John surname: de Wit fullname: de Wit, John organization: Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia – sequence: 4 givenname: John surname: Rule fullname: Rule, John organization: School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia – sequence: 5 givenname: Andrew surname: Carr fullname: Carr, Andrew organization: Centre for Applied Medical Research, St Vincent's Hospital, Sydney, New South Wales, Australia – sequence: 6 givenname: Krista J surname: Siefried fullname: Siefried, Krista J organization: Centre for Applied Medical Research, St Vincent's Hospital, Sydney, New South Wales, Australia |
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Keywords | out-of-pocket health care expenditure virological failure HIV co-payment antiretroviral therapy adherence |
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Snippet | •Removal of patient co-payments for ART did not reduce total out-of-pocket healthcare expenditure•Co-payment removal did not improve ART adherence or reduce... In 2015, New South Wales (Australia) removed patient co-payments for ART of HIV. We hypothesized the policy change would reduce overall out-of-pocket (OOP)... BACKGROUNDIn 2015, New South Wales (Australia) removed patient co-payments for ART of HIV. We hypothesized the policy change would reduce overall out-of-pocket... |
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SubjectTerms | adherence Adult antiretroviral therapy Australia co-payment Health Expenditures HIV HIV Infections - drug therapy Humans out-of-pocket health care expenditure Poverty Prospective Studies virological failure |
Title | Impact of the removal of patient co-payments for antiretroviral therapy (ART) on out-of-pocket expenditure, adherence and virological failure among Australian adults living with HIV |
URI | https://dx.doi.org/10.1016/j.healthpol.2021.07.002 https://www.ncbi.nlm.nih.gov/pubmed/34340883 https://search.proquest.com/docview/2557549700 |
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