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Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia
BACKGROUND: Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guideli...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229087/ https://www.ncbi.nlm.nih.gov/pubmed/25389777 http://dx.doi.org/10.1371/journal.pone.0108304 |
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author | Tagar, Elya Sundaram, Maaya Condliffe, Kate Matatiyo, Blackson Chimbwandira, Frank Chilima, Ben Mwanamanga, Robert Moyo, Crispin Chitah, Bona Mukosha Nyemazi, Jean Pierre Assefa, Yibeltal Pillay, Yogan Mayer, Sam Shear, Lauren Dain, Mary Hurley, Raphael Kumar, Ritu McCarthy, Thomas Batra, Parul Gwinnell, Dan Diamond, Samantha Over, Mead |
author_facet | Tagar, Elya Sundaram, Maaya Condliffe, Kate Matatiyo, Blackson Chimbwandira, Frank Chilima, Ben Mwanamanga, Robert Moyo, Crispin Chitah, Bona Mukosha Nyemazi, Jean Pierre Assefa, Yibeltal Pillay, Yogan Mayer, Sam Shear, Lauren Dain, Mary Hurley, Raphael Kumar, Ritu McCarthy, Thomas Batra, Parul Gwinnell, Dan Diamond, Samantha Over, Mead |
author_sort | Tagar, Elya |
collection | PubMed |
description | BACKGROUND: Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. METHODS & FINDINGS: In 2010–2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2–8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77–95% alive and on treatment). CONCLUSIONS: This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation. |
format | Online Article Text |
id | pubmed-4229087 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-42290872014-11-18 Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia Tagar, Elya Sundaram, Maaya Condliffe, Kate Matatiyo, Blackson Chimbwandira, Frank Chilima, Ben Mwanamanga, Robert Moyo, Crispin Chitah, Bona Mukosha Nyemazi, Jean Pierre Assefa, Yibeltal Pillay, Yogan Mayer, Sam Shear, Lauren Dain, Mary Hurley, Raphael Kumar, Ritu McCarthy, Thomas Batra, Parul Gwinnell, Dan Diamond, Samantha Over, Mead PLoS One Research Article BACKGROUND: Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. METHODS & FINDINGS: In 2010–2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2–8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77–95% alive and on treatment). CONCLUSIONS: This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation. Public Library of Science 2014-11-12 /pmc/articles/PMC4229087/ /pubmed/25389777 http://dx.doi.org/10.1371/journal.pone.0108304 Text en © 2014 Tagar et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Tagar, Elya Sundaram, Maaya Condliffe, Kate Matatiyo, Blackson Chimbwandira, Frank Chilima, Ben Mwanamanga, Robert Moyo, Crispin Chitah, Bona Mukosha Nyemazi, Jean Pierre Assefa, Yibeltal Pillay, Yogan Mayer, Sam Shear, Lauren Dain, Mary Hurley, Raphael Kumar, Ritu McCarthy, Thomas Batra, Parul Gwinnell, Dan Diamond, Samantha Over, Mead Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia |
title | Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia |
title_full | Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia |
title_fullStr | Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia |
title_full_unstemmed | Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia |
title_short | Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia |
title_sort | multi-country analysis of treatment costs for hiv/aids (match): facility-level art unit cost analysis in ethiopia, malawi, rwanda, south africa and zambia |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229087/ https://www.ncbi.nlm.nih.gov/pubmed/25389777 http://dx.doi.org/10.1371/journal.pone.0108304 |
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