The costs and benefits of private sector provision of treatment to HIV-infected employees in Kampala, Uganda.
OBJECTIVE
The objective of this study was to determine the financial incentives that companies have to treat HIV-infected employees, in a health care services company in Kampala, Uganda.


METHODS
Cost-benefit analysis from the company's perspective of three interventions to treat HIV-infected employees.


METHODS
The costs and benefits of each intervention were compared with no intervention and with each other: cotrimoxazole prophylaxis (CTX) starting at WHO stage 2; highly active antiretroviral therapy (HAART) plus CTX starting at WHO stage 2; and a 'hybrid' strategy that begins with CTX at WHO stage 2 and later includes HAART. The 5-year health and economic outcomes were calculated using a Markov model. Inputs for disease progression rates and effects of HIV on company costs were derived from published and unpublished data and a survey administered to company officers.


RESULTS
The analysis showed that the 'hybrid' intervention is the most cost-effective. For 100 skilled employees it would save the company 38,939 US dollars and 73 disability adjusted life-years (DALYs). For unskilled workers 'CTX' is the most cost effective and would save 16,417 US dollars and 60 DALYs. 'Hybrid' has an incremental cost-effectiveness ratio of 45 US dollars per DALY for unskilled workers whereas HAART is far less economical at an incremental cost per DALY of 4118 US dollars. For 'CTX', net savings are preserved across the full range of input values.


CONCLUSIONS
A 'hybrid' intervention combining CTX prophylaxis followed by HAART would generate savings to a Ugandan company. Governments and other donors may find opportunities to share costs with the private sector as part of their phase-in strategy for antiretroviral therapy.
Health Strategies International, Orinda, California 94563, USA. emarseille@comcast.net
Elliot
E
Marseille
Joseph
J
Saba
Sowedi
S
Muyingo
James G
JG
Kahn
D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D017049:Employer Health Costs / Q000706:statistics & numerical data; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics* / Q000517:prevention & control; D006801:Humans; D017059:Models, Econometric; D009786:Occupational Health Services / Q000191:economics*; D017149:Private Sector / Q000191:economics*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000191:economics / Q000627:therapeutic use; D014454:Uganda
D019380:Anti-HIV Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination