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Unit Costs for Delivery of Antiretroviral Treatment and Prevention of Mother-to-Child Transmission of HIV

A Systematic Review for Low- and Middle-Income Countries

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Abstract

As antiretroviral treatment (ART) for HIV/AIDS is scaled up globally, information on per-person costs is critical to improve efficiency in service delivery and to maximize coverage and health impact. The objective of this study was to review studies on unit costs for delivery of adult and paediatric ART per patient-year, and prevention of mother-to-child transmission (PMTCT) interventions per mother-infant pair screened or treated, in lowand middle-income countries. A systematic review was conducted of English, French and Spanish publications from 2001 to 2009, reporting empirical costing that accounted for at least antiretroviral (ARV) medicines, laboratory testing and personnel. Expenditures were analysed by country-income level and cost component. All costs were standardized to $US, year 2009 values. Several sensitivity analyses were conducted.

Analyses covered 29 eligible, comprehensive, costing studies. In the base case, in low-income countries (LIC), median ART cost per patient-year was $US792 (mean: 839, range: 682–1089); for lower-middle-income countries (LMIC), the median was $US932 (mean: 1246, range: 156–3904); and, for upper-middle-income countries (UMIC), the median was $US1454 (mean: 2783, range: 1230–5667). ARV drugs were the largest component of overall ART costs in all settings (64%, 50% and 47% in LIC, LMIC and UMIC, respectively). Of 26 ART studies, 14 reported the drug regimes used, and only one study explicitly reported second-line treatment costs. The second cost driver was laboratory cost in LIC and LMIC (14% and 20%), and personnel costs in UMIC (26%). Two ART studies specified the types of laboratory tests costed, and three studies specifically included above facility-level personnel costs. Three studies reported detailed PMTCT costs, and three studies reported on paediatric ART.

There is a paucity of data on the full unit costs for delivery of ART and PMTCT, particularly for LIC and middle-income countries. Heterogeneity in activities costed, and insufficient detail regarding components included in the costing, hampers standardization of unit cost measures. Evaluation of programme-level unit costs would benefit frominternational guidance on standardized costing methods, and expenditure categories and definitions. Future work should help elucidate the sources of the large variations in delivery unit costs across settings with similar income and epidemiological characteristics.

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Acknowledgements

The authors thank Daniel Acuña, who conducted the initial bibliographic search, as well as Lazarus Muchabaiwa and Jesse Kigozi for their research assistance. The authors also acknowledge Sergio Bautista-Arredondo, Lisa DeMaria, Steven Forsythe, Lori Bollinger, Megan O’Brien and various participants at the first Latin America & the Caribbean Conference on Global Health in Cuernavaca, Mexico and at the XVIII International AIDS Conference in Vienna, Austria, for helpful comments. The research was partially funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (PO♯2008301) through the National Institute of Public Health (INSP)/Consortium for Research on HIV/AIDS and Tuberculosis (CISIDAT[63]). Additional funding for Omar Galárraga was provided by the US National Institutes of Health (NIH)/Fogarty International Center (K01-TW008016-02) through the Institute of Business and Economic Research (IBER) at the University of California, Berkeley, CA, USA. The opinions expressed in the review do not reflect the views of any of the funding or other organizations that supported or facilitated the study. The authors are solely responsible for the contents; they report no conflicts of interest.

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Authors and Affiliations

  1. Health Services, Policy and Practice (Health Economics), Brown University, Providence, Rhode Island, USA

    Omar Galárraga

  2. Center for Evaluation Research and Surveys, Division of Health Economics, National Institute of Public Health (INSP)/Mexican School of Public Health, Cuernavaca, Mexico

    Omar Galárraga & Yared Santa-Ana-Tellez

  3. Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico

    Veronika J. Wirtz & Alejandro Figueroa-Lara

  4. The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland

    Ibrahima Coulibaly, Kirsi Viisainen & Eline L. Korenromp

  5. Center for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy

    Antonieta Medina-Lara

  6. Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

    Eline L. Korenromp

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  1. Omar Galárraga
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Correspondence to Veronika J. Wirtz.

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Galárraga, O., Wirtz, V.J., Figueroa-Lara, A. et al. Unit Costs for Delivery of Antiretroviral Treatment and Prevention of Mother-to-Child Transmission of HIV. Pharmacoeconomics 29, 579–599 (2011). https://doi.org/10.2165/11586120-000000000-00000

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