A new study conducted by the Clinton Health Access Initiative (CHAI), in partnership with five African countries and the Center for Global Development, has determined that HIV treatment costs are far lower than previously believed. This study provides new evidence that aggressive scale‐up of high‐quality treatment in developing countries is possible and sustainable.
The study, the largest‐ever of its kind, was conducted at 161 health facilities in Ethiopia, Malawi, Rwanda, Zambia and South Africa over the course of 2011. It found that the average facility level cost of HIV treatment — which includes antiretrovirals (ARVs) and other drugs, laboratory tests, health worker salaries and other out‐patient costs — is an average of $200 per patient per year across the first four countries. In South Africa, the average is $682. (The difference was largely attributed to higher labor and laboratory costs in South Africa.)
At the same time, CHAI announced that it has negotiated new price reductions of up to 30% with generic drug makers for some of the most important ARVs used today. The new prices, effective immediately, are available to more than 70 countries included in CHAI’s procurement consortium. This latest price reduction was achieved with the generous support of UNITAID, the UK Department for International Development and the Bill and Melinda Gates Foundation. The Gates Foundation also provided funding for the costing study.
“We now have compelling evidence that universal access to high‐quality HIV treatment is achievable, sustainable, and within our means,” said President Bill Clinton. “Together, the costing study and price reductions open the door to scaling up and sustaining services for the 7 million people who currently lack access to HIV treatment. Providing treatment will save lives and help prevent the spread of HIV to their partners.”
The study was conducted in part to determine whether additional savings could be achieved at health facilities by improving the efficiency of service delivery — for example, by shifting tasks to lower‐level, lower‐paid healthcare workers. The findings suggest that making these changes are unlikely to generate significant savings in terms of cost in low and lower‐middle income countries. This is due to the fact that ‘input costs’ — such as the salary of a nurse, or cost of a laboratory test — are very low.
Such shifts, however, may be important to expand access to services and to improve quality of care for patients. In higher income countries such as South Africa, there are likely be savings opportunities that bear further investigation.
“We now understand that health facilities are running lean operations, but we can still work to make their treatment programs simpler, smarter and faster,” said Dr. Bernhard Schwartländer, Director for Evidence, Innovation and Policy at UNAIDS. “By transferring responsibility to communities and to national governments, we can reach even more people and make the most of our scarce resources. I am glad that HIV programmes are moving in this direction and the international community, especially PEPFAR, is supporting these shifts.”
The new drug prices include a significant reduction for tenofovir‐based drug regimens, the “gold standard” in the U.S. and one of two preferred first‐line treatment options in the 2010 World Health Organization guidelines. This regimen is now available in its once‐daily, two‐pill form for $125 per patient per year in developing countries; an $184 decrease in price from 2008. Price reductions on the tenofovir regimen alone are expected to save countries over US$500 million between now and 2015. These savings will provide governments with additional flexibility as they make decisions about what products to buy and how to expand their HIV/AIDS programs.
In addition, a new one‐pill, once per day version of atazanavir plus ritonavir, a key component of second‐line treatment, means that countries can now treat second‐line patients with a more convenient option that is priced over $100 less than the alternative.
“The new prices mean that we will be able to provide optimal treatment to more people with our current resources. This will help reduce the tradeoffs Ministries like ours often have to make between the cost and quality of treatment,” said Dr. Yibeltal Assefa, Director, Plan, Monitoring and Evaluation Directorate, Ethiopia Federal HIV/AID Prevention and Control Office. “In addition, the results of this study should reassure donors that their investments in HIV have been used wisely. We have been able to keep costs low at our hospitals and health centers without sacrificing the quality of care provided.”
