The Health Economics & HIV/AIDS Research Division at the University of Natal, Durban held the last seminar of its 2001 series on Tuesday, 20 November 2001.
The seminar, presented by Patrick Connelly from Boston University, looked at the cost of treating HIV/AIDS with ARVs in South Africa, and was based on the findings from Connelly's recently
Given that there are an estimated 4.7 million people infected with HIV in South Africa, 500,000 of whom have already progressed to AIDS and will likely die within two years, the fact that only 10,000 of these people currently have access to highly active anti-retroviral therapy (HAART) is indicative of the level of inequity still existent within our health system. A number of areas of the health sector have embarked on studies to investigate the feasibility of using antiretrovirals (ARVs) by analyzing the cost of
Connelly's presentation summarized and categorized these studies into studies based on modeling (projections) directed at government policy makers (public sector), cost analyses undertaken by the mining sector, and actual cost per patient data produced by disease management schemes (private sector). Following are some of the findings from the paper.
Studies projecting the cost of ARVs in the public sector
- Abt Associates produced a report in November 2000 for the National DoH that projected the costs of treating PLHA with ARVs in the public and private sector. It remains confidential.
- Futures Group will complete a study estimating the cost and cost effectiveness of the use of ARVs in the public health sector in November 2001 for the National
- The Social Security Committee of Inquiry will complete a policy oriented cost study in November 2001.
- The Treatment Action Campaign (TAC) is collaborating with other researchers to estimate the costs of using ARVs in different interventions in the public health sector in order to influence government policy. The study is expected to be complete in January 2002.
- The Chamber of Mines projects the cost of treating an HIV infected employee over a period of ten years to be between R70-80,000.
- DeBeers has completed cost estimates and will make a decision in December whether to provide ARVs to all employees.
- AngloAmerican will offer HAART to senior management and will also conduct a pilot study to determine the feasibility of expanding HAART. Anglo currently considers R1500 a month for HAART unaffordable and a wide scale programme too difficult to implement for all employees.
Disease Management Programmes
- Aid for Aids (AfA) reports HAART treatment to be approximately R1850 per month.
- QUALSA reports treatment costs are between R26,467 and R38,484 per year.
- Aids Management and Support reports an average cost of R26,976 per year.
Delays in discovering the actual costs of treating AIDS with HAART through the public health system in South Africa are due to lack of support of ARVs by the government and the formerly high price of ARVs. Only one population based modelling study has been completed and only a few are being finalized that will estimate the cost of offering HAART to South Africans not covered by the private sector. Disease management schemes have documented the costs of treating the few who are receiving HAART in South Africa. The mining industry has projected costs of treating their employees, but no company has decided to initiate treatment to all their employees.
A recent decline in drug prices and the advent of the United Nations Global AIDS and Health Fund, make the possibility of HAART in the developing world more conceivable. However, multiple operational studies by all areas of the South African health sector are needed to find the most efficient method of delivery of HAART and to convince the leadership of the efficacy of
Source: HEARD, University of Natal, Durban, 20 November 2001