# Cost-Effectiveness of Linkage Case Management for Hospitalized People With HIV

## TL;DR

A case management program for hospitalized HIV patients in Tanzania was more costly but improved health outcomes, making it likely cost-effective.

## Contribution

This study provides new evidence on the cost-effectiveness of a linkage case management intervention for HIV care in a resource-limited setting.

## Key findings

- Daraja was more costly than standard care from both the Ministry of Health and societal perspectives.
- The intervention led to a reduction in disability-adjusted life-years (DALYs) at both 3 and 12 months.
- Daraja had a 0.75 probability of being cost-effective across various willingness-to-pay thresholds.

## Abstract

Is a case management intervention to improve HIV care engagement cost-effective compared with enhanced standard care from Tanzanian Ministry of Health and societal perspectives?

In this economic evaluation including 500 patients, Daraja, a linkage case management intervention administered by social workers, was more costly than enhanced standard care from both stakeholder perspectives but was associated with improvements in disability-adjusted life-years. At 12 months, Daraja’s likelihood of cost-effectiveness was approximately 0.75 across a wide range of willingness-to-pay thresholds.

The Daraja intervention had a high probability of being regarded as cost-effective according to various cost-effectiveness threshold estimates.

This economic evaluation examines the cost-effectiveness of the Daraja case management intervention compared with enhanced standard care for hospitalized patients with HIV from the Tanzania Ministry of Health and societal perspectives.

The Daraja randomized clinical trial was a linkage case management intervention designed to improve HIV care engagement. Understanding the economic value of this type of case management intervention is essential to decision-makers in resource-constrained settings seeking to minimize HIV-related morbidity and mortality.

To evaluate the cost-effectiveness of Daraja compared with enhanced standard care from the Tanzania Ministry of Health and societal perspectives.

This prospective economic evaluation was conducted alongside the Daraja randomized clinical trial at 20 hospitals in Northwestern Tanzania from March 2019 to May 2023. Participants were patients hospitalized with HIV randomly assigned 1:1 to receive either the Daraja intervention or enhanced standard care and were followed up for 12 months through March 2023. Data were analyzed from May 2024 to March 2025.

The Daraja intervention group received up to 5 sessions conducted by a social worker at the hospital, in the home, and in the HIV clinic over a 3-month period. The enhanced standard care group received predischarge HIV counseling and assistance in scheduling an HIV clinic appointment.

The primary outcome was the cost per disability-adjusted life-year (DALY) averted for Daraja vs standard care, assessed from Ministry of Health and societal perspectives at 3 months (intervention) and 12 months (intervention plus follow-up).

Among 500 participants, the mean (SD) age was 37 [12] years, and 384 participants (77%) were female. Participants in the intervention group incurred more costs from the Tanzanian Ministry of Health perspective over the 3-month intervention period ($43.4 vs $24.0; difference, $19.4 [95% CI, $9.2 to $29.6]) and over the 12-month observation period ($101.6 vs $78.2; difference, $23.4 [95% CI, $8.0 to $38.9]). From the societal perspective, Daraja incurred more costs than standard care at 3 months ($72.4 vs $47.4; difference, $25.0 [95% CI, $2.0 to $48.0]) but not 12 months ($182.7 vs $160.5; difference, $22.2 [95% CI, −$16.4 to 60.8]). DALYs were lower for Daraja participants at both the 3-month (1.2 [95% CI, 1.1 to 1.2] DALYs averted, annualized) and 12-month (1.1 [95% CI, 1.3 to 3.7] DALYs averted) time points.

In this economic evaluation of the Daraja intervention, Daraja was more costly than standard care from both the Tanzanian Ministry of Health and societal perspectives; however, it was associated with improvements in DALYs. These findings suggest that Daraja has a high probability of being considered cost-effective from both economic perspectives.