HIV treatment as prevention: modelling the cost of antiretroviral treatment--state of the art and future directions.
Policy discussions about the feasibility of massively scaling up antiretroviral therapy (ART) to reduce HIV transmission and incidence hinge on accurately projecting the cost of such scale-up in comparison to the benefits from reduced HIV incidence and mortality. We review the available literature on modelled estimates of the cost of providing ART to different populations around the world, and suggest alternative methods of characterising cost when modelling several decades into the future. In past economic analyses of ART provision, costs were often assumed to vary by disease stage and treatment regimen, but for treatment as prevention, in particular, most analyses assume a uniform cost per patient. This approach disregards variables that can affect unit cost, such as differences in factor prices (i.e., the prices of supplies and services) and the scale and scope of operations (i.e., the sizes and types of facilities providing ART). We discuss several of these variables, and then present a worked example of a flexible cost function used to determine the effect of scale on the cost of a proposed scale-up of treatment as prevention in South Africa. Adjusting previously estimated costs of universal testing and treatment in South Africa for diseconomies of small scale, i.e., more patients being treated in smaller facilities, adds 42% to the expected future cost of the intervention.
Center for Global Health and Development, Boston University, Boston, Massachusetts, United States of America. gesine@bu.edu
Gesine
G
Meyer-Rath
Mead
M
Over
D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D003365:Costs and Cost Analysis; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D006801:Humans; D018803:Models, Economic; D011787:Quality of Health Care / Q000191:economics; D013019:South Africa; D016896:Treatment Outcome
D019380:Anti-HIV Agents