New Strategies Needed to Offset HIV Treatment Costs

The increasing cost of antiretroviral therapy (ART) may be offset by implementing novel cost-saving approaches, according to a study published by PLOS ONE.

In the study, the authors analyzed the cost of the South African HIV treatment program and projected the costs associated with the 2009 World Health Organization (WHO) guidelines.

The researchers discovered that the annual cost of ART will likely continue on an upward trend until a universal treatment protocol is fully implemented, according to the study. In 2016, the authors noted that South Africa introduced a universal HIV program.

“The paper summarizes our close collaboration with the South African Department of Health and Treasury over the last 8 years, which resulted in us helping to change public policy—an unusual situation for an academic,” says lead author Gesine Meyer-Rath, MD, PhD. “While many factors have contributed to the remarkable expansion of HIV treatment in South Africa over the last decade, with the political will demonstrated by the current minister of health being the most important one, our model supported the process by allowing the Department of Health to submit budget bids to treasury that were based on precise estimates of patients in need of treatment and overall costs.”

Currently, the South African ART program provides services for more than 4 million patients. The cost for the government-funded program has been increasing since it was implemented, which may call for innovative approaches to reduce spending.

“The cost of this program, which has risen steadily since its inception in 2004, has been and remains one of the major challenges confronting the South African government as it seeks to expand access to treatment and sustain or improve quality of service delivery,” the authors wrote. “The National South African Department of Health faces the double challenge of expanding eligibility for and coverage of the HIV treatment program while simultaneously reducing the per-person cost of treatment.”

The authors analyzed the cost and effect of the program and developed a budget impact model, which accounts for WHO guidelines and how to offset costs. The authors investigated how implementing procurement, health systems, and technical improvements would change costs, according to the study.

The authors projected that introducing task-shifting and opening the program for international competition would significantly counteract the increase in treatment costs under 2009 guidelines, according to the study.

The authors also noted that adherence programs may also help offset costs associated with universal treatment.

As the program reaches universal coverage, the authors found that these measures would lead to a reduction in overall costs by 2024, according to the study.

“Annual budgetary requirements for ART will continue to increase in South Africa until universal treatment is taken to full scale,” the authors wrote. “Model results were instrumental in changing South African ART guidelines, more than tripling the population on treatment between 2009 and 2017, and reducing the per-patient cost of treatment by 64%.”