Cost-effectiveness of differentiated HIV service delivery in North Wollo, Ethiopia: a retrospective study
- 1Department of Pharmacy, Woldia University, Woldia, Ethiopia
- 2Department of Pharmacy, Debre Berhan University, Debre Birhan, Ethiopia
Abstract
Background: Differentiated service delivery (DSD) models have been introduced to optimise HIV care by tailoring services to patient needs, but evidence on their cost-effectiveness in Ethiopia is limited.
Objective: To evaluate the cost-effectiveness of DSD models for HIV care compared with standard of care (SOC) in North Wollo, Ethiopia.
Study design: Retrospective economic evaluation using bottom-up microcosting from a healthcare provider perspective.
Setting: One hospital and three health centres in North Wollo Zone, Ethiopia, from January 2024 to December 2024.
Participants: 786 adults (≥18 years) on antiretroviral therapy, including 393 receiving DSD (across nine models: 6-month multimonth dispensing, 3-month multimonth dispensing, appointment spacing, community antiretroviral therapy (ART) groups (CAG), FastTrack, maternal and child health, peer-led, adolescent groups and key population models) and 393 receiving SOC.
Main outcome measures: Total annual cost per patient (USD), retention in care at 12 months (%) and incremental cost-effectiveness ratios (ICERs) expressed as cost per additional patient retained.
Statistical analysis: Costs were annualised at a 3% discount rate. ICERs were calculated comparing each DSD model to SOC. Deterministic one-way sensitivity analysis (±20% for medication cost and retention rate) assessed robustness.
Results: SOC had the highest annual cost per patient (US$295) and lowest retention (76.6%). All DSD models were dominant (lower cost, higher retention) with negative ICERs. CAG was the most cost-effective (US$199 per patient; 93.0% retention; ICER –5.85), followed by FastTrack (US$212; 92.9%; –5.09) and adolescent groups (US$238; 90.5%; –4.10). Sensitivity analyses confirmed robustness; no scenario reversed dominance.
Conclusion: DSD models, particularly CAG, FastTrack and adolescent groups, provide more cost-effective HIV care than SOC in Ethiopia by achieving higher retention at lower costs. Scaling up these models could optimise resource allocation and reduce health system burden.
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BibTeX
@article{tarekegn2026costeffectiveness,
title = {{Cost-effectiveness of differentiated HIV service delivery in North Wollo, Ethiopia: a retrospective study}},
author = {Tenaw Baye Tarekegn and Teshome Bitew Demelash},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-120948},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120948},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Cost-effectiveness of differentiated HIV service delivery in North Wollo, Ethiopia: a retrospective study
AU - Tenaw Baye Tarekegn
AU - Teshome Bitew Demelash
PY - 2026
DA - 2026/10/05
JO - BMJ Open
DO - 10.1136/bmjopen-2026-120948
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120948
AB - Background: Differentiated service delivery (DSD) models have been introduced to optimise HIV care by tailoring services to patient needs, but evidence on their cost-effectiveness in Ethiopia is limited. Objective: To evaluate the cost-effectiveness of DSD models for HIV care compared with standard of care (SOC) in North Wollo, Ethiopia. Study design: Retrospective economic evaluation using bottom-up microcosting from a healthcare provider perspective. Setting: One hospital and three health centres in North Wollo Zone, Ethiopia, from January 2024 to December 2024. Participants: 786 adults (≥18 years) on antiretroviral therapy, including 393 receiving DSD (across nine models: 6-month multimonth dispensing, 3-month multimonth dispensing, appointment spacing, community antiretroviral therapy (ART) groups (CAG), FastTrack, maternal and child health, peer-led, adolescent groups and key population models) and 393 receiving SOC. Main outcome measures: Total annual cost per patient (USD), retention in care at 12 months (%) and incremental cost-effectiveness ratios (ICERs) expressed as cost per additional patient retained. Statistical analysis: Costs were annualised at a 3% discount rate. ICERs were calculated comparing each DSD model to SOC. Deterministic one-way sensitivity analysis (±20% for medication cost and retention rate) assessed robustness. Results: SOC had the highest annual cost per patient (US$295) and lowest retention (76.6%). All DSD models were dominant (lower cost, higher retention) with negative ICERs. CAG was the most cost-effective (US$199 per patient; 93.0% retention; ICER –5.85), followed by FastTrack (US$212; 92.9%; –5.09) and adolescent groups (US$238; 90.5%; –4.10). Sensitivity analyses confirmed robustness; no scenario reversed dominance. Conclusion: DSD models, particularly CAG, FastTrack and adolescent groups, provide more cost-effective HIV care than SOC in Ethiopia by achieving higher retention at lower costs. Scaling up these models could optimise resource allocation and reduce health system burden.
SN - 2044-6055
SN - 2044-6055
ER -