Per-patient costs of delivering antiretroviral treatment for HIV: a review for low and middle income countries
O. Galarraga1, V. Wirtz2, A. Medina-Lara3, A. Figueroa-Lara2, Y. Santa Ana Tellez2, I. Coulibaly4, K. Viisainen4, E. Korenromp4
1National Institute of Public Health (INSP), Health Economics, Cuernavaca, Mexico, 2INSP, Cuernavaca, Mexico, 3University of Liverpool, School of Management, Liverpool, United Kingdom, 4Global Fund on AIDS, Tuberculosis and Malaria, Geneva, Switzerland
Background: Demand and program capacity to implement antiretroviral treatment (ART) are now approaching, and sometimes even exceeding, available health budgets in several low-income countries. Global health financing organizations are committed to supporting countries to measure per-person costs of key services. This information is critical to improve efficiency in service delivery, and maximize health effects.
Objective: To systematically review the literature to estimate program-level delivery unit costs for adult antiretroviral treatment (ART) in low- and middle-income countries.
Methods: A systematic review of the literature from 2001 to 2009 was conducted using PubMed, EconLit and POPLINE, and websites of international donor organizations. Included were empirical measurements of program-level expenditures, based on micro-costing, step-down or ingredients approaches that reported (at least) antiretroviral (ARV) drugs/medicines, laboratory testing, and human resource costs as separate cost components. Cost findings were analyzed by country income level (according to the World Bank classification: low-income, lower-middle and upper-middle), after transformation into 2009 US dollars.
Results: Out of 202 articles assessed, 30 met the pre-established eligibility criteria addressing adult ART costs. For low-income countries the median cost per adult patient-year for first-line ART was US$212 (range: $132-$514). In lower-middle-income countries, first-line ART had a median of $651 (range: $97-$5503), and in upper-middle-income countries the median cost was $1022 (range: $228-1795). In all settings, ARV drugs/medicines were the largest component of overall treatment delivery cost, followed by human resources and laboratory costs.
Conclusions: There is a paucity of information on per-patient costs in different settings and the relative efficiency of different delivery systems. Heterogeneity in program implementation and costing methodologies make it difficult to define global benchmarks based on published studies. More research is needed to document per person costs of delivering ART in low-income countries, and to uncover the sources of differences in costs among countries with similar income levels.
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