The cost of providing comprehensive HIV treatment in PEPFAR-supported programs

October 17, 2011

Global funding for HIV control has increased substantially over the past 10 years, and by 2008 more than $15 billion was being devoted to combatting the HIV epidemic, the majority of this funding devoted to providing care and antiretroviral therapy (ART) for HIV-infected individuals. The funding devoted to HIV treatment dwarfs the resources available for many other health concerns, yet the demand for treatment is greater still, with only around one-third of those in need of ART currently receive care. As the international economic downturn puts further pressure on the HIV control budget, treatment programs must seek to understand the costs of care and aggressively pursue efficiencies where they can be found. For this to be accomplished there is a critical need for empirical data describing the treatment costs experienced by operating treatment programs.

In the most recent issue of AIDS, CHDS PhD candidate Nick Menzies has helped fill this information gap. The study is the first peer-reviewed article of its kind; in which Nick and coauthors estimate the per-patient costs of HIV treatment costs in various countries around the world. Nick’s analysis draws on a unique dataset on HIV treatment costs experienced by 43 PEPFAR-supported treatment sites across 5 countries.  He and his colleagues gathered cost data over multiple 6-month periods so as to calculate the annual economic costs for both pre- and current-ART patients and how these costs changed over time. They found that per-patient costs dropped as the treatment site matured, with nearly a 50% reduction in per-patient costs over the 1st year of operations. Additionally, their analyses revealed the non-trivial contribution of administrative and management activities to total treatment costs, and the substantial proportion of treatment costs supported by PEPFAR in the sites that it funds. The cost results were sensitive to country setting as well as showing substantial variability between sites. This research will help programs understand the cost structure of HIV treatment and undertake more precise predictions of the trajectory of HIV treatment costs in the future.