Abstract
BackgroundIn economic analyses of HIV interventions, South Africa is often used as a case in point, due to the availability of good epidemiological and programme data and the global relevance of its epidemic. Few analyses however use locally relevant cost data. We reviewed available cost data as part of the South African HIV Investment Case, a modelling exercise to inform the optimal use of financial resources for the country’s HIV programme.MethodsWe systematically reviewed publication databases for published cost data covering a large range of HIV interventions and summarised relevant unit costs (cost per person receiving a service) for each. Where no data was found in the literature, we constructed unit costs either based on available information regarding ingredients and relevant public-sector prices, or based on expenditure records.ResultsOnly 42 (5%) of 1,047 records included in our full-text review reported primary cost data on HIV interventions in South Africa, with 71% of included papers covering ART. Other papers detailed the costs of HCT, MMC, palliative and inpatient care; no papers were found on the costs of PrEP, social and behaviour change communication, and PMTCT. The results informed unit costs for 5 of 11 intervention categories included in the Investment Case, with the remainder costed based on ingredients (35%) and expenditure data (10%).ConclusionsA large number of modelled economic analyses of HIV interventions in South Africa use as inputs the same, often outdated, cost analyses, without reference to additional literature review. More primary cost analyses of non-ART interventions are needed.
Highlights
In economic analyses of HIV interventions, South Africa is often used as a case in point, due to both the size of its HIV-positive population and the number of people in need of and receiving services as well as the availability of good data on the course of its HIV epidemic and the outcomes of interventions
42 (5%) of 1,047 records included in our full-text review reported primary cost data on HIV interventions in South Africa, with 71% of included papers covering antiretroviral treatment (ART)
Other papers detailed the costs of HIV counselling and testing (HCT), MMC, palliative and inpatient care; no papers were found on the costs of pre-exposure prophylaxis (PrEP), social and behaviour change communication, and PMTCT
Summary
In economic analyses of HIV interventions, South Africa is often used as a case in point, due to both the size of its HIV-positive population and the number of people in need of and receiving services as well as the availability of good data on the course of its HIV epidemic and the outcomes of interventions. A large number of economic evaluations of antiretroviral treatment (ART) options for low- and middle-income countries have used South Africa as a case study for decisions facing international donors supporting HIV programmes in sub-Saharan Africa more generally [1,2,3,4,5,6,7] Very few of these analyses use cost inputs from South Africa, despite the fact that the South African. The Investment Case used a novel optimisation methodology to inform local programme planners and both local and international funders about the most cost effective mix of interventions against both HIV and TB in South Africa over the twenty years, using as the main outcome measure cost per life-year gained It started with a long list of interventions proposed during a stakeholder workshop which was subjected to a rigorous review of the evidence regarding each intervention’s effectiveness. Editor: Nicky McCreesh, London School of Hygiene and Tropical Medicine, UNITED KINGDOM
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