XVIII International AIDS Conference


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Total cost and potential cost savings of the national antiretroviral treatment (ART) programme in South Africa 2010 to 2017

Presented by Gesine Meyer-Rath (United States).

G. Meyer-Rath1,2, A. Brennan1,2, L. Long2,3, S. Rosen1,2,3, Y. Pillay4, L. Johnson5, M. Fox1,2,3

1Boston University School of Public Health, Center for Global Health and Development, Boston, United States, 2Health Economics and Epidemiology Research Office, Johannesburg, South Africa, 3University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa, 4National Department of Health, Pretoria, South Africa, 5University of Cape Town, Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa

Background: Due to the pace of scale-up, South Africa's ART program, with about 980,000 patients the largest in the world, experiences funding and staffing shortages.
Methods: We developed a dynamic health-state transition model to calculate the cost of the national ART program and potential cost savings. The model used projections of patients in need of and accessing ART by the ASSA AIDS model and rates of death, loss to follow-up, failure and transition between health states from large Johannesburg ART cohorts (n = 15,502). Data were analysed by CD4 cell stratum and 6-month interval on ART. Per patient cost was estimated at the same clinics and broken down by time on ART (pre-ART, 0-6 months, > 6 months) and type of treatment. Number of patients on ART and total cost in 2010 USD were calculated over 7 financial years (2010/11 to 2016/17).
Results: We compared numbers of patients on treatment and total cost for several scenarios (see Table). We included task-shifting and the procurement of drugs at Clinton Foundation ceiling prices. Depending on eligibility criteria, drug selection, and failure incidence, total numbers on ART will increase by 83-115% and annual cost by 96%-159% over the next 7 years. Task-shifting alone would decrease total cost by 10-11%; both task-shifting and lower drug prices by 14-24%.

ScenarioTotal patients in care [thousands]Total cost [million USD 2010]
  Staffing and drug cost as currentWith task-shifting and fixed-dose combinations
 2010/ 20112016/ 20172010/ 20112016/ 2017Total2010/ 20112016/ 2017Total
Old guidelines? Eligibility at CD4 cell count <200 cells/µl ? First line d4T+3TC+EFV or NVP ? Second line AZT+ddI+LPVr1,3822,5269321,82810,0697021,3757,661
Maximum? Same as above, but eligibility at <350 cells/µl ? Early paediatric treatment1,7113,0721,2132,62114,8859762,29912,793
New guidelines? Eligibility at <350 for pregnant women and TB/HIV co-infected; at <200 cells/µl for all other ? Early paediatric treatment ? First line TDF+3TC+EFV or NVP ? Second line AZT+ddI+LPVr1,5183,2681,0792,79614,5278702,46512,536
[Total patients in care and total cost by scenario]

Conclusions: Total budgetary requirements will continue to increase in South Africa but can be in part offset by changes to staffing and drug procurement.

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