BACKGROUND: The role of antiretroviral treatment for adults in the pubic sector in South Africa is debated with little consideration of programme choices that could impact on the cost-effectiveness of the intervention. This study seeks to explore the impact of these programme choices at an individual level, as well as explore the total cost of a rationed national public sector antiretroviral treatment programme. METHODS: Eight scenarios were modelled of limited national treatment programmes over the next 5 years, reflecting different programme design choices. The individual cost-effectiveness of these scenarios were compared. The total costs of the most cost-effective scenario were calculated, and the potential for savings in other areas of health care utilisation was explored. RESULTS: The direct programme costs per life-year saved varied between scenarios from R5,923 to R11,829. All the costs of the most cost-effective scenario could potentially be offset depending on assumptions of health care access and utilisation. The total programme costs for the most cost-effective scenario in 2007 with 107,000 people on treatment are around R409 million. CONCLUSION: Specific policy choices could almost double the number of people who could benefit from an investment in a limited national antiretroviral treatment programme. Such a programme is affordable within current resource constraints. The consideration of antiretroviral treatment calls for a unique public health approach to the rationing of health services in the public sector.
BACKGROUND: The role of antiretroviral treatment for adults in the pubic sector in South Africa is debated with little consideration of programme choices that could impact on the cost-effectiveness of the intervention. This study seeks to explore the impact of these programme choices at an individual level, as well as explore the total cost of a rationed national public sector antiretroviral treatment programme. METHODS: Eight scenarios were modelled of limited national treatment programmes over the next 5 years, reflecting different programme design choices. The individual cost-effectiveness of these scenarios were compared. The total costs of the most cost-effective scenario were calculated, and the potential for savings in other areas of health care utilisation was explored. RESULTS: The direct programme costs per life-year saved varied between scenarios from R5,923 to R11,829. All the costs of the most cost-effective scenario could potentially be offset depending on assumptions of health care access and utilisation. The total programme costs for the most cost-effective scenario in 2007 with 107,000 people on treatment are around R409 million. CONCLUSION: Specific policy choices could almost double the number of people who could benefit from an investment in a limited national antiretroviral treatment programme. Such a programme is affordable within current resource constraints. The consideration of antiretroviral treatment calls for a unique public health approach to the rationing of health services in the public sector.
Authors: Elliot Marseille; James G Kahn; Christian Pitter; Rebecca Bunnell; William Epalatai; Emmanuel Jawe; Willy Were; Jonathan Mermin Journal: Appl Health Econ Health Policy Date: 2009 Impact factor: 2.561
Authors: Motasim Badri; Gary Maartens; Sundhiya Mandalia; Linda-Gail Bekker; John R Penrod; Robert W Platt; Robin Wood; Eduard J Beck Journal: PLoS Med Date: 2005-12-06 Impact factor: 11.069
Authors: Elliot Marseille; Mark J Giganti; Albert Mwango; Angela Chisembele-Taylor; Lloyd Mulenga; Mead Over; James G Kahn; Jeffrey S A Stringer Journal: PLoS One Date: 2012-12-20 Impact factor: 3.240