Abstract
BackgroundBy the end of 2011 Global Fund investments will be supporting 3.5 million people on antiretroviral therapy (ART) in 104 low- and middle-income countries. We estimated the cost and health impact of continuing treatment for these patients through 2020.Methods and FindingsSurvival on first-line and second-line ART regimens is estimated based on annual retention rates reported by national AIDS programs. Costs per patient-year were calculated from country-reported ARV procurement prices, and expenditures on laboratory tests, health care utilization and end-of-life care from in-depth costing studies. Of the 3.5 million ART patients in 2011, 2.3 million will still need treatment in 2020. The annual cost of maintaining ART falls from $1.9 billion in 2011 to $1.7 billion in 2020, as a result of a declining number of surviving patients partially offset by increasing costs as more patients migrate to second-line therapy. The Global Fund is expected to continue being a major contributor to meeting this financial need, alongside other international funders and domestic resources. Costs would be $150 million less in 2020 with an annual 5% decline in first-line ARV prices and $150–370 million less with a 5%–12% annual decline in second-line prices, but $200 million higher in 2020 with phase out of stavudine (d4T), or $200 million higher with increased migration to second-line regimens expected if all countries routinely adopted viral load monitoring. Deaths postponed by ART correspond to 830,000 life-years saved in 2011, increasing to around 2.3 million life-years every year between 2015 and 2020.ConclusionsAnnual patient-level direct costs of supporting a patient cohort remain fairly stable over 2011–2020, if current antiretroviral prices and delivery costs are maintained. Second-line antiretroviral prices are a major cost driver, underscoring the importance of investing in treatment quality to improve retention on first-line regimens.
Highlights
As of the end of 2009, over 5 million people were receiving antiretroviral treatment (ART) globally [1]; 2.5 million people through programs co-financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) [3]
While studies have projected increased financing needs to treat all those who need it [6], none have estimated the level of financing required to support the patients currently receiving antiretroviral therapy (ART), which could be seen as a minimum to funding requirements
The Global Fund does not support all of these costs; the USA President’s Emergency Plan for AIDS Relief (PEPFAR), other donors, national governments and other domestic resources provide partial support for the patients benefiting from Global Fund investments
Summary
As of the end of 2009, over 5 million people were receiving antiretroviral treatment (ART) globally [1]; 2.5 million people through programs co-financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) [3]. We use new data on Global Fund financing of ART programs to estimate the future funding required to enable the cohort of 3.5 million persons expected to be receiving ART in Global Fundsupported programs as of 2011 to continue receiving treatment through 2020. By the end of 2011 Global Fund investments will be supporting 3.5 million people on antiretroviral therapy (ART) in 104 low- and middle-income countries. We estimated the cost and health impact of continuing treatment for these patients through 2020
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