Analysis of Health-Related Quality of Life and Incurred Costs Among Human Immunodeficiency Virus, Tuberculosis, and Tuberculosis/HIV Coinfected Outpatients in Indonesia

• Published in: Value in health regional issues Vol. 41; pp. 32 - 40
• Main Authors: Idrus, Lusiana R., Fitria, Najmiatul, Purba, Fredrick D., Alffenaar, Jan-Willem C., Postma, Maarten J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2024
• Subjects: Adult; Coinfection - economics; Coinfection - epidemiology; Cross-Sectional Studies; Female; Health Care Costs - statistics & numerical data; Health Expenditures - statistics & numerical data; health-related quality of life; healthcare costs; HIV; HIV Infections - complications; HIV Infections - economics; HIV Infections - epidemiology; HIV Infections - psychology; Humans; Indonesia - epidemiology; Male; Middle Aged; Outpatients - psychology; Outpatients - statistics & numerical data; Quality of Life - psychology; Surveys and Questionnaires; tuberculosis; Tuberculosis - economics; Tuberculosis - epidemiology; Tuberculosis - psychology; Indonesia; health-related quality of life; HIV; healthcare costs; tuberculosis
• ISSN: 2212-1099; 2212-1102
• DOI: 10.1016/j.vhri.2023.10.010

A growing interest in healthcare costs and patients’ health-related quality of life (HRQoL) exists in the context of the increasing importance of health technology assessment in countries with high numbers of the HIV and tuberculosis (TB) patient populations, such as Indonesia. This study aimed to analyze the HRQoL and out-of-pocket (OOP) costs of HIV, TB, and TB/HIV coinfected participants in a city in Indonesia with a high prevalence of HIV and TB.
A cross-sectional survey was conducted in the voluntary counseling and testing and lung clinics of Bekasi City Public Hospital (Indonesia) from January to March 2018. Patients’ HRQoL was measured using the EQ-5D-5L questionnaire, whereas OOP costs were extracted from a semistructured questionnaire.
Of the 460 eligible participants, 82% resided in the city, 48% of them were married, and their median age was 34 years. Less than half were insured, and more than half had no source of income. The median values of health utilities for participants with HIV, TB, and TB/HIV were perceived as potentially high (1.0, 0.9, and 0.8, respectively). The TB/HIV coinfected outpatients had the highest OOP costs (US$94.5), with the largest contribution coming from direct medical OOP expenditures. Taking loans from family members was adopted as a financial strategy to overcome inadequate household incomes and high treatment costs.
This study suggests that TB/HIV coinfection potentially lowers HRQoL and increases healthcare costs and the need for economic analysis to underpin cost-effective treatment in such patients.
•Advanced HIV and tuberculosis (TB) treatments have increased the likelihood of successful treatment outcomes.•This study demonstrated the high value of health-related quality of life in patients treated in a city with a high prevalence of HIV and TB infectious diseases; however, out-of-pocket costs were also observed, which could contribute to the financial burden of the patient’s household.•This study highlights the need for greater government commitment to HIV and TB infectious diseases in terms of disease mitigation, priority scale to surmount treatment problems, and the improvement of personalized treatment.