title: Long-term costs and health impact of continued global fund support for antiretroviral therapy.
abstract: BACKGROUND
  By the end of 2011 Global Fund investments will be supporting 3.5 million people on antiretroviral therapy (ART) in 104 low- and middle-income countries. We estimated the cost and health impact of continuing treatment for these patients through 2020.
  
  
  RESULTS
  Survival on first-line and second-line ART regimens is estimated based on annual retention rates reported by national AIDS programs. Costs per patient-year were calculated from country-reported ARV procurement prices, and expenditures on laboratory tests, health care utilization and end-of-life care from in-depth costing studies. Of the 3.5 million ART patients in 2011, 2.3 million will still need treatment in 2020. The annual cost of maintaining ART falls from $1.9 billion in 2011 to $1.7 billion in 2020, as a result of a declining number of surviving patients partially offset by increasing costs as more patients migrate to second-line therapy. The Global Fund is expected to continue being a major contributor to meeting this financial need, alongside other international funders and domestic resources. Costs would be $150 million less in 2020 with an annual 5% decline in first-line ARV prices and $150-370 million less with a 5%-12% annual decline in second-line prices, but $200 million higher in 2020 with phase out of stavudine (d4T), or $200 million higher with increased migration to second-line regimens expected if all countries routinely adopted viral load monitoring. Deaths postponed by ART correspond to 830,000 life-years saved in 2011, increasing to around 2.3 million life-years every year between 2015 and 2020.
  
  
  CONCLUSIONS
  Annual patient-level direct costs of supporting a patient cohort remain fairly stable over 2011-2020, if current antiretroviral prices and delivery costs are maintained. Second-line antiretroviral prices are a major cost driver, underscoring the importance of investing in treatment quality to improve retention on first-line regimens.
authors: Futures Institute, Glastonbury, Connecticut, United States of America. jstover@futuresinstitute.org
authors: John
authors: J
authors: Stover
authors: Eline L
authors: EL
authors: Korenromp
authors: Matthew
authors: M
authors: Blakley
authors: Ryuichi
authors: R
authors: Komatsu
authors: Kirsi
authors: K
authors: Viisainen
authors: Lori
authors: L
authors: Bollinger
authors: Rifat
authors: R
authors: Atun
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D005378:Financial Support; D015658:HIV Infections / Q000191:economics / Q000401:mortality; D017048:Health Care Costs; D006801:Humans; D038622:Internationality; D016019:Survival Analysis; D013997:Time Factors