Triple therapy for a quarter of HIV-infected South Africans would cost $19 billion over five years, even taking into account drastic price cuts hinted at by some manufacturers, according to a projection published today in The Lancet.
However, provision of short-course prophylaxis for 25% of HIV-positive pregnant women would cost only $1.8 million and would prevent approximately 30,000 HIV infections over a five year period. This level of intervention was modelled in order to reflect the difficulties of implementing treatment given the current health care infrastructure, and the fact that only 50% of HIV-positive women actually return to receive their diagnosis after consenting to a test.
More extensive uptake of prophylaxis (assumed to be short course nevirapine in the cost model) led to corresponding reductions in the number of HIV-positive infants and cumulative AIDS cases.
If 75% of pregnant women with HIV receive prophylaxis, the number of HIV-infected infants would fall by 83,000, and if prophylaxis could be implemented universally for all women who might give birth between 2000 and 2005, the number of HIV-positive infants would fall by 110,000, but there would still be 166,000 HIV-positive infant births.
Whilst triple therapy for a quarter of HIV-infected South Africans would prevent an estimated 431,000 new AIDS cases between 200 and 2005, it would eat up approximately 12.5% of South African health care spending. However, the model does not take into account any knock-on effects on the rate of HIV transmission
|
Antiretroviral intervention |
Cumulative AIDS cases 2000-2005 |
Cumulative HIV-positive infants born |
Total drug cost |
|
Do nothing |
2.3 million |
276,000 |
Nothing |
|
25% prophylaxis |
2.27 million |
248,000 |
$1.8 million |
|
Universal use of prophylaxis |
2.17 million |
166,000 |
$52 million |
|
Triple therapy for 25% of adults |
1.87 million |
276,000 |
$19 billion |
Key assumptions of the model
- 95% of adults develop AIDS within 6 years of infection
- 50% of infants develop AIDS within 2 years of infection
- Median reduction in perinatal transmission of 40%
- Life extended by median of 6 years by use of triple combination therapy
- Median cost of antiretroviral prophylaxis of $8
- Estimated cost of triple therapy: $2900
- Baseline prevalence of HIV: 12%, prevalence by 2005, 15%
- Perinatal transmission rate among breastfeeding women: 30%
Reference
Wood E et al. Extent to which low-level use of antiretroviral treatment could curb the AIDS epidemic in sub-Saharan Africa. The Lancet 355: 2095-2100, 2000.