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Long-Term Costs and Health Impact of Continued Global Fund Support for Antiretroviral Therapy

Author

Listed:
  • John Stover
  • Eline L Korenromp
  • Matthew Blakley
  • Ryuichi Komatsu
  • Kirsi Viisainen
  • Lori Bollinger
  • Rifat Atun

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. Methods and Findings: 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.

Suggested Citation

  • John Stover & Eline L Korenromp & Matthew Blakley & Ryuichi Komatsu & Kirsi Viisainen & Lori Bollinger & Rifat Atun, 2011. "Long-Term Costs and Health Impact of Continued Global Fund Support for Antiretroviral Therapy," PLOS ONE, Public Library of Science, vol. 6(6), pages 1-7, June.
  • Handle: RePEc:plo:pone00:0021048
    DOI: 10.1371/journal.pone.0021048
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    Cited by:

    1. Stephen Resch & Eline Korenromp & John Stover & Matthew Blakley & Carleigh Krubiner & Kira Thorien & Robert Hecht & Rifat Atun, 2011. "Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries," PLOS ONE, Public Library of Science, vol. 6(10), pages 1-9, October.
    2. Isaac Iyinoluwa Olufadewa & Miracle Ayomikun Adesina & Ruth Ifeoluwa Oladele & Moyinoluwa Joshua Oladoye & Nnenne Florence‐Ayambem Eke, 2021. "Global fund: Analyzing 10 Years of bridging health inequalities," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(2), pages 282-287, March.
    3. Bruno Ventelou & Yves Arrighi & Robert Greener & Erik Lamontagne & Patrizia Carrieri & Jean-Paul Moatti, 2012. "The Macroeconomic Consequences of Renouncing to Universal Access to Antiretroviral Treatment for HIV in Africa: A Micro-Simulation Model," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-12, April.

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