Perceived Cost Advantages and Disadvantages of Purchasing HIV Self-Testing Kits among Urban Tanzanian Men: An Inductive Content Analysis

Impoverished men have lower rates of facility-based HIV counseling and testing and higher unknown HIV-positive status than women. Economic theory suggests that individuals will obtain an HIV test if anticipated benefits are greater than anticipated costs. Yet, few studies have investigated the range of financial preferences of HIV self-testing (HIVST) among poor men who decline testing or do not test regularly. Twenty-three interviews were conducted to qualitatively assess perceived costs saved and costs incurred from use of HIVST kits in infrequently- or never-tested Tanzanian men. All men were shown an HIVST kit and video. They were then asked about the costs associated with provider-led HIV testing, financial benefits and concerns of HIVST and willingness to pay for HIVST. Data were transcribed, coded and analyzed using inductive content analyses. We then grouped codes into perceived cost advantages and disadvantages and tabulated the range of prices men were willing to pay for a self-test kit. Perceived cost advantages of HIVST were avoidance of spending money to test in facilities, omission of follow-up fees, affordability relative to private clinics, and increased time for earning income and other activities. Men also discussed the imbalance of the financial benefit of accessing free, public HIV testing with the resources spent for transport, purchasing meals away from home and long wait lines. Perceived cost disadvantages of HIVST were prohibitive kit costs, required prior savings to purchase kits, expenditures relating to death and preferences for free provider-performed testing. Men were also concerned about the psychological costs of inaccurate results. HIVST willingness to pay varied among men. Men’s decisions to self-test for HIV takes into account expected financial gains and losses. Demand generation for HIVST among men should consider use of low fees or free HIVST, while emphasizing potential savings from reduced travel, clinical costs, or time way from work. Efforts are also needed to address anticipated emotional costs of HIVST, such as anxiety from kit errors, purchasing “death” or testing alone, which for some men was a substantial barrier.

Economic Benefits and Treatment Progress as Determinants of the Sustainability of Vietnamese Voluntary Co-Located Patients Clusters

BACKGROUND

Over the past 15 years or so, in Vietnam, a phenomenon has steadily grown more and more widespread: the forming of co-located patients communities. Poor patients choose to live together, seeking/lending supports from/to one another. Despite the undeniable existence of these communities, little is researched or known about how co-located patients perceive the value of what they receive as cluster members, or how they assess their future connection to the communities they are living in.

MATERIALS AND METHODS

The study employs multiple logistic regressions method to investigate relationships between factors such as perceived satisfaction from community-provided financial means, reported health improvements, along with patients' short-and longer-term commitments to these communities.

RESULTS

The results suggest meaningful empirical relationships: 1) between, on one hand, gender, perceived values and sustainability of patients communities, financial stress faced by patients and the financial benefits they received from the community, and, on the other hand, their propensity to stay connected to it; and 2) between economic conditions, length of stay with a community, general level of satisfaction, health improvements on one hand and long-term commitment to these communities on the other hand.

CONCLUSIONS

Patients who choose to stick to co-location clusters do so for an economic reason: finding means to fight their financial hardship. This may suggest a degree of complication higher than one would have thought in dealing with poor patients from a social point of view. Concretely, the majority of the public only focuses on charity programs and in-king donations, while ignoring the more sustainable - and, at the same time, more complicated - alternative which is to create suitable income-generating jobs for patient. In addition, patients are not only those who seek to ask for supports but can potentially be the donors contributing to the sustainability of those voluntary communities.

A new perspective on the value of minimally invasive colorectal surgery-payer, provider, and patient benefits

BACKGROUND

The clinical benefits of minimally invasive surgery (MIS) are proven, but overall financial benefits are not fully explored. Our goal was to evaluate the financial benefits of MIS from the payer's perspective to demonstrate the value of minimally invasive colorectal surgery.

METHODS

A Truven MarketScan^® claim-based analysis identified all 2013 elective, inpatient colectomies. Cases were stratified into open or MIS approaches based on ICD-9 procedure codes; then costs were assessed using a similar distribution across diagnosis related groups (DRGs). Care episodes were compared for average allowed costs, complication, and readmission rates after adjusting costs for demographics, comorbidities, and geographic region.

RESULTS

A total of 4615 colectomies were included-2054 (44.5 %) open and 2561 (55.5 %) MIS. Total allowed episode costs were significantly lower MIS than open ($37,540 vs. $45,284, p < 0.001). During the inpatient stay, open cases had significantly greater ICU utilization (3.9 % open vs. 2.0 % MIS, p < 0.001), higher overall complications (52.8 % open vs. 32.3 % MIS, p < 0.001), higher colorectal-specific complications (32.5 % open vs. 17.9 % MIS, p < 0.001), longer LOS (6.39 open vs. 4.44 days MIS, p < 0.001), and higher index admission costs ($39,585 open vs. $33,183 MIS, p < 0.001). Post-discharge, open cases had significantly higher readmission rates/100 cases (11.54 vs. 8.28; p = 0.0013), higher average readmission costs ($3055 vs. $2,514; p = 0.1858), and greater 30-day healthcare costs than MIS ($5699 vs. $4357; p = 0.0033). The net episode cost of care was $7744/patient greater for an open colectomy, even with similar DRG distribution.

CONCLUSIONS

In a commercially insured population, the risk-adjusted allowed costs for MIS colectomy episodes were significantly lower than open. The overall cost difference between MIS and open was almost $8000 per patient. This highlights an opportunity for health plans and employers to realize financial benefits by shifting from open to MIS for colectomy. With increasing bundled payment arrangements and accountable care sharing programs, the cost impact of shifting from open to MIS introduces an opportunity for cost savings.