Kenyon CR, Boulle A; International Conference on AIDS.

Int Conf AIDS. 2002 Jul 7-12; 14: abstract no. TuOrG1247.

Health Systems Trust, Cape Town, South Africa

ISSUES: Many cost-effectiveness analyses on Highly Active Antiretroviral Treatment (HAART) programmes in high HIV-prevalence countries in Sub-Saharan Africa have concluded that such programmes are unaffordable. DESCRIPTION: This paper argues that these previous cost-effectiveness studies have made two crucial errors which greatly inflate the costs. Firstly, the numbers treated will be significantly lower than those used in studies such as the World Bank study, as numbers will be constrained by factors such as human resource limits. Secondly, the input costs could be greatly reduced through the use of a Scheduled Regime approach, minimising laboratory costs and the use of generic Antiretrovirals (ARVs). We present our own cost-effectiveness analysis for just such a potential programme in the South African setting, based on local costs and effectiveness data. We critically evaluate the individual-level cost-effectiveness of this intervention by comparing the cost per life-year gained of analogous and competing interventions. We have stratified treatment approaches, and explored the marginal value of the progressive intensification of treatment regimes and medical follow-up. The paper concludes by arguing that although difficult to quantify, the population-level benefits of a rationed ARV programme for an epidemic at the stage of South Africa's are significant. These benefits would provide further backing to the argument for setting up a limited ARV treatment programme in South Africa. LESSONS LEARNED: A limited ARV programme in South Africa would be both cost-effective for the individuals who benefit, and an extremely good-value public health intervention in the control of the spread of HIV. RECOMMENDATIONS: We argue that there is compelling evidence for the establishment of a rationed ARV treatment programme in South Africa.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Africa South of the Sahara
• Antiretroviral Therapy, Highly Active
• Cost-Benefit Analysis
• Costs and Cost Analysis
• Demography
• Disease Outbreaks
• HIV Infections
• HIV-1
• Humans
• Population
• Population Groups
• Retroviridae
• South Africa
• drug therapy
• economics
• methods
• therapy

Other ID:

• GWAIDS0019389

UI: 102256887

From Meeting Abstracts