Antiretroviral therapy is cost-effective, says report

A new study says the benefits of a public sector rollout of antiretroviral therapy (ART) to people living with HIV/AIDS outweigh the costs of not doing so. The report, 'Cost-effectiveness of Antiretroviral Treatment for HIV-Positive Adults in a South African Township', is based on research conducted at three HIV-dedicated clinics in Khayelitsha township on the outskirts of Cape Town. Life in the township is characterised by high levels of unemployment (about 40 percent), high crime rates, a shortage of basic services and mostly informal housing. Apart from being the site of one of the oldest ART pilot programmes in the country, Khayelitsha allowed the authors of the report to study the costs and efficacy of ART in a setting close to that envisaged for the public sector rollout of antiretrovirals (ARVs). The study was conducted by the School of Public Health and Family Medicine at the University of Cape Town, which found that ART offered "immense benefits" to those enrolled on the pilot programme and to society in general. The researchers noted that "in terms of the overall efficiency of the [HIV/AIDS] intervention, this research has calculated that ART costs R13,754 [about US $2,096] per quality-adjusted life-year (QALY)". The QALY is a measure combining both the quality and quantity of life. Healthcare costs for HIV-positive people not on ART amounted to R14,189 (US $2,162) per QALY. "This result indicates that ART is efficient in economic terms, and ought to be pursued if economically feasible and desirable to society ... furthermore, ART can prevent some of the devastation associated with the early mortality of breadwinners and caregivers that is currently being felt across the continent," the researchers commented. "The clinical results on which this study is based are a clear demonstration of the potential for the intervention to extend life and delay many of the individual and societal consequences associated with premature mortality," the report explained. The cost-effectiveness of ART also improves markedly as the prices of ARVs drop. "Fortunately, various recent changes have opened far more opportunities for the procurement of generic ARVs. South African generic manufacturer Aspen Pharmacare has developed the capacity to manufacture generic versions of ddl, 3TC, AZT, Combivir and Nevirapine (under licence) ... at about US $1 a day for a first-line regimen," the study noted. The current focus on reducing the cost of ARVs is warranted "as, on the whole, ARVs still account for nearly 50 percent of the lifetime cost of ART". While expenditure on personnel was not a major cost-driver, the challenge remained to recruit and train sufficient human resources to deliver the ART rollout. The study concluded that even though an intervention may be "economically efficient, it would not necessarily be affordable", and affordability "is an important issue in this case, because of the sheer number of people that need ART" in South Africa.