Abstract
Since the early 2000s, aid organizations and developing country governments have invested heavily in AIDS treatment. By 2010, more than five million people began receiving antiretroviral therapy (ART) – yet each year, 2.7 million people are becoming newly infected and another two million are dying without ever having received treatment. As the need for treatment grows without commensurate increase in the amount of available resources, it is critical to assess the health and economic gains being realized from increasingly large investments in ART. This study estimates total program costs and compares them with selected economic benefits of ART, for the current cohort of patients whose treatment is cofinanced by the Global Fund to Fight AIDS, Tuberculosis and Malaria. At end 2011, 3.5 million patients in low and middle income countries will be receiving ART through treatment programs cofinanced by the Global Fund. Using 2009 ART prices and program costs, we estimate that the discounted resource needs required for maintaining this cohort are $14.2 billion for the period 2011–2020. This investment is expected to save 18.5 million life-years and return $12 to $34 billion through increased labor productivity, averted orphan care, and deferred medical treatment for opportunistic infections and end-of-life care. Under alternative assumptions regarding the labor productivity effects of HIV infection, AIDS disease, and ART, the monetary benefits range from 81 percent to 287 percent of program costs over the same period. These results suggest that, in addition to the large health gains generated, the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment.
Highlights
Flows of bilateral and multilateral aid over the past decade, combined with the domestic financial contributions of many countries, have fueled a remarkable scale-up in AIDS treatment and prevention programs in low and middle income countries
We calculated the ratio of the full program costs to the set of economic benefits generated through the program
Our analysis focuses on the valuation of economic benefits and related costs that accrue from maintaining current patients in antiretroviral therapy (ART) programs being cofinanced by the Global Fund and a range of other complementary domestic and external sources
Summary
Flows of bilateral and multilateral aid over the past decade, combined with the domestic financial contributions of many countries, have fueled a remarkable scale-up in AIDS treatment and prevention programs in low and middle income countries. Starting with just a few thousand patients in 2002, UNAIDS and WHO report that by the end of 2009 more than five million people were enrolled in antiretroviral therapy (ART) programs in these countries [1] Despite these impressive gains, only a third of the estimated 15 million HIV-infected persons with the most acute need (according to the WHO’s 2010 eligibility definition) have access to treatment [1,2]. The 2008–2010 global recession, flattening aid budgets, and fiscal tightening in many AIDS-affected countries are threatening the ability of donors and countries to continue scaling up ART In this context, policy makers deciding whether to commit additional resources to ART programs will want to consider the cost and health impacts of program continuation, and the likely economic benefits of doing so
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