Provision of antiretroviral treatment through workplace
health schemes in South Africa has the potential to save substantial sums for
employers, as well as making a major contribution to treatment scale-up in the
region, a new study presented at
19th International AIDS Conference (AIDS 2012) in
Washington DC shows.
Very large sums in employee sickness and death-in-service
benefits could be saved, according to Peter Vickerman of the London School of
Hygiene and Tropical Medicine, who presented a modelling study based on the
costs of antiretroviral treatment provision in a large mining company. He found
that the cost of drugs comprised just 5% of the HIV-related costs incurred by
Although a growing number of companies in southern Africa
provide HIV treatment through workplace programmes, his work is the first
economic evaluation of the cost-benefit of providing antiretroviral
treatment, and is likely to open eyes in any board room with significant
interests in southern Africa.
The study looked at the costs of providing treatment in a
large mining company operating two mines north of Johannesburg, which have been
providing HIV-related medical care at outpatient facilities at the mines since
2003. Treatment is currently provided to all employees with HIV with CD4 cell
counts below 350, as per international guidance.
Rather than just looking at the costs of treatment and life
years saved in isolation, the analysis took into account the costs to the company
of providing HIV-related benefits such as sick pay and death-in-service
benefits, as well as the estimated costs of absenteeism in lost production, and
the costs of training and recruiting new staff. The analysis also took into
account the cost of setting up and running the HIV-related medical services. The
model employed workforce data gathered between 2003 and 2010, and projected all
the costs out to 2022.
The company employed 7000 to 8000 miners during the period
2003-10, and the model projects that
– assuming a continued prevalence of around
15% and an annual HIV incidence of 1to 2%
– the company can expect to be
employing around 2000 HIV-positive staff in any given year.
In any year after
2011, the model assumed that 75% of those eligible will start treatment, but
loss to follow-up will lie in the region of 5 to 11%, due to workforce turnover
and migration to other ART programmes.
The modelling exercise found that the total cost of
HIV-positive employees was 17% lower as a result of antiretroviral treatment
provision, and the cost of absenteeism would be cut by one-third as a result of reduced sickness-related absenteeism. The 'HIV tax' on
the business (the total costs of HIV to the business as a percentage of the
payroll) fell from 6.3 to 5.6% as a result of ART provision.
The big surprise of the modelling exercise was just how
little the provision of antiretroviral drugs contributed to the overall costs
of HIV to the business, and how much was saved by their provision to employees. Antiretroviral drugs comprised
just 5% of the total costs of HIV to the business, at just US$1.4 million per
year. In comparison, benefits and absenteeism each cost the business over US$10
million a year without ART. Spending US$1.4 million per year on antiretroviral
treatment was associated with an annual saving of US$4.3 million on benefits
and absenteeism, and a net annual saving of US$5 million to the business.
Peter Vickerman stressed that results might vary in other
companies depending on their benefits policy. In the case of the company
studied, for example, the death-in-service benefit paid to surviving relatives
was three times annual salary. Similarly, results may not be generalisable to
other countries in the region with lower wages.
Nevertheless, the findings that companies operating in the
region could expect to make substantial net savings if they introduce or expand
antiretroviral treatment provision among employees are likely to make employers
look more carefully at how to provide treatment, particularly where benefits
and absenteeism are important business costs.