Journal Article

Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia

Moyo, Crispin, Dain, Mary, Hurley, Raphael, Nyemazi, Jean Pierre, Assefa, Yibeltal, Batra, Parul, McCarthy, Thomas, Chilima, Ben, Chitah, Bona Mukosha, Kumar, Ritu, Matatiyo, Blackson, Chimbwandira, Frank, Over, Mead, Pillay, Yogan, Condliffe, Kate, Mayer, Sam, Tagar, Elya, Shear, Lauren, Sundaram, Maaya, Mwanamanga, Robert, Gwinnell, Dan, Diamond, Samantha

2014

Overview

Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. In 2010-2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2-8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77-95% alive and on treatment). This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Acquired Immunodeficiency Syndrome - drug therapy / Acquired Immunodeficiency Syndrome - economics / AIDS / Anti-Retroviral Agents - economics / Anti-Retroviral Agents - therapeutic use / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Biology and Life Sciences / CD4-Positive T-Lymphocytes - cytology / Communicable Disease Control / Communicable Diseases - economics / Cost analysis / Costs / Developing Countries - economics / Drug therapy / Ethiopia / Health Care Costs / Health Services Accessibility / Health Services Needs and Demand - economics / HIV / HIV Infections - drug therapy / HIV Infections - economics / Human immunodeficiency virus / Humans / Malawi / Medicine and health sciences / Models, Economic / Patients / Planning / Random sampling / Resource allocation / Rwanda / Social Sciences / South Africa / Systematic review / Treatment Outcome / Zambia