An economic case for providing free access to antiretroviral therapy for HIV-positive people in South Australia.
BACKGROUND
As financial constraints can be a barrier to accessing HIV antiretroviral therapy (ART), we argue for the removal of copayment requirements from HIV medications in South Australia.


METHODS
Using a simple mathematical model informed by available behavioural and biological data and reflecting the HIV epidemiology in South Australia, we calculated the expected number of new HIV transmissions caused by persons who are not currently on ART compared with transmissions for people on ART. The extra financial investment required to cover the copayments to prevent an HIV infection was compared with the treatment costs saved due to averting HIV infections.


RESULTS
It was estimated that one HIV infection is prevented per year for every 31.4 persons (median, 24.0-42.7 interquartile range (IQR)) who receive treatment. By considering the incremental change in costs and outcomes of a change in program from the current status quo, it would cost the health sector $17860 per infection averted (median, $13651-24287 IQR) if ART is provided as a three-dose, three-drug combination without requirements for user-pay copayments.


CONCLUSIONS
The costs of removing copayment fees for ART are less than the costs of treating extra HIV infections that would result under current conditions. Removing the copayment requirement for HIV medication would be cost-effective from a governmental perspective.
Faculty of Medicine, The University of New South Wales, Sydney, NSW 2010, Australia.
Kelly-Jean
KJ
Heymer
Matthias
M
Wentzlaff-Eggebert
Elissa
E
Mortimer
David P
DP
Wilson
D000553:Ambulatory Care / Q000191:economics*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics; D015233:Models, Statistical; D009313:National Health Programs / Q000191:economics; D013021:South Australia / Q000453:epidemiology