Cost and outcomes of paediatric antiretroviral treatment in South Africa.

OBJECTIVE: Little is known about the cost of paediatric antiretroviral treatment (ART) in low-income and middle-income countries. We analysed the average cost of providing paediatric ART in South Africa during the first 2 years after ART initiation, stratified by patient outcomes.
METHODS: We collected data on outpatient resource use and treatment outcomes of 288 children in two Johannesburg public clinics, Empilweni Services and Research Unit (ESRU) and Harriet Shezi Children's Clinic (HSCC) from 2005 to 2009. Patient-level resource use was estimated from patient records. Unit cost data came from site accounts and public-sector sources. Patient outcomes at month 12 and 24 after initiation were defined based on patients' weight CD4 cell counts/percentages, viral loads, and the presence of new WHO stage 3/4 conditions.
RESULTS: Median age/CD4 percentage at initiation was 4.03 years/12.40% in ESRU and 5.84 years/14.05% in HSCC, respectively. Sixty-two and 91% of patients remained in care and responding to treatment at month 12 in ESRU and HSCC, respectively, and 68 and 80% at month 24. The average cost per patient in care and responding was US$ 830 in year 1 and US$ 717 in year 2 in ESRU and US$ 678 and US$ 782 in HSCC. Antiretroviral drugs comprised 33-52% of total cost, clinic visits 23-31%, lab tests 12-16%, and fixed costs 8-18%.
CONCLUSIONS: Costs varied between the two clinics but were comparable with those of adult ART. Few very young children accessed ART in either clinic and those who did were already very ill, emphasizing the importance of early infant treatment.