Cost-Effectiveness of Highly Active Antiretroviral Therapy in South Africa

Background: Little information exists on the impact of highly active antiretroviral therapy (HAART) on health-care provision in South Africa despite increasing scale-up of access to HAART and gradual reduction in HAART prices. Methods and Findings: Use and cost of services for 265 HIV-infected adults without AIDS (World Health Organization [WHO] stage 1, 2, or 3) and 27 with AIDS (WHO stage 4) receiving HAART between 1995 and 2000 in Cape Town were compared with HIV-infected controls matched for baseline WHO stage, CD4 count, age, and socioeconomic status, who did not receive antiretroviral therapy (ART; No-ART group). Costs of service provision (January 2004 prices, US$1 = 7.6 Rand) included local unit costs, and two scenarios for HAART prices for WHO recommended first-line regimens: scenario 1 used current South African public-sector ART drug prices of $730 per patient-year (PPY), whereas scenario 2 was based on the anticipated public-sector price for locally manufactured drug of $181 PPY. All analyses are presented in terms of patients without AIDS and patients with AIDS. Conclusion: HAART is a cost-effective intervention in South Africa, and cost saving when HAART prices are further reduced. Our estimates, however, were based on direct costs, and as such the actual cost saving might have been underestimated if indirect costs were also included. Healthcare costs for HIV-infected South African adults on HAART compared with costs for HIV-infected controls not on HAART. Authors conclude HAART is cost effective. Background: The number of cases of AIDS continues to increase worldwide; the disease is a major threat to humanity, with Africa facing the very worst problems. In South Africa alone there were 370,000 AIDS deaths in 2003. AIDS is caused by a type of retrovirus—the human immunodeficiency virus (HIV). Highly active antiretroviral treatment (HAART) is a treatment that uses a combination of three or more antiretroviral drugs that attack different parts of the virus. HAART is expensive, making it difficult for poor countries to provide treatment for all who need it. Prices are falling, however, and South Africa is one country where efforts are now being made to improve access to treatment. Why Was This Study Done?: The cost-effectiveness of HAART has been studied in developed countries, but developing countries also need to know how much it is going to cost their health services if they introduce HAART, and whether there will be financial savings because of switching to a more effective treatment. What Did the Researchers Do and Find?: During the study period (January 1995 to 31 December 2000), HAART was not available in the publicly funded South African health-care sector. The study, funded by the drug manufacturer Bristol-Myers Squibb, took place in HIV clinics affiliated with the University of Cape Town. The researchers compared the cost of services for 292 patients who were given HAART with the costs for a comparison group (with the same number of patients) who were not given any antiretroviral drugs. Twenty-seven patients in each group had AIDS; the others were HIV-infected but did not have AIDS. The researchers calculated costs per patient year (PPY) and per life-year gained (LYG), i.e., the total cost divided by the number of extra years the treated patients lived. Calculations were done separately for patients with AIDS and those without AIDS. Patients on HAART required fewer hospital admissions. Depending on how long the patient survived and the price of antiretrovirals, it cost less to treat the HAART patients with AIDS. For this group, the cost saving ranged from $219 to $2,116 (in U.S. dollars). For patients without AIDS, the cost of treatment (ranging from $597 to $1,772) was, by the South African standard of cost of living, affordable. However, it is expected that South Africa will soon be able to manufacture antiretroviral drugs locally and more cheaply. This would increase the amount saved by introducing HAART. What Does This Mean?: HAART seems to be a more cost-effective way for South African hospitals to treat HIV infection than simply waiting for patients to come to hospital and then dealing with their symptoms. However, it should be noted that when a person is infected with HIV and becomes ill or dies from AIDS, it is not only hospitals that face costs. The patient, their family, and the country suffer financially. Effective treatment might also lower these “indirect” costs, but this was not an issue examined in this research. Where Can I Find More Information Online?: For a comprehensive source of information on HIV/AIDS: