Multi-country analysis of treatment costs for HIV/AIDS (MATCH): facility-level ART unit cost analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia

PLoS One. 2014 Nov 12;9(11):e108304. doi: 10.1371/journal.pone.0108304. eCollection 2014.

Abstract

Background: Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia.

Methods & findings: In 2010-2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2-8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77-95% alive and on treatment).

Conclusions: This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / drug therapy
  • Acquired Immunodeficiency Syndrome / economics*
  • Anti-Retroviral Agents / economics*
  • Anti-Retroviral Agents / therapeutic use
  • CD4-Positive T-Lymphocytes / cytology
  • Communicable Disease Control
  • Communicable Diseases / economics
  • Developing Countries / economics
  • Ethiopia
  • HIV Infections / drug therapy
  • HIV Infections / economics*
  • Health Care Costs
  • Health Services Accessibility
  • Health Services Needs and Demand / economics
  • Humans
  • Malawi
  • Models, Economic
  • Rwanda
  • South Africa
  • Treatment Outcome
  • Zambia

Substances

  • Anti-Retroviral Agents

Grant support

The funder for this work was the Bill and Melinda Gates Foundation (www.gatesfoundation.org) through the following grant: WO5, Contract 19419. The funders provided technical input into the study design, data collection and analysis. They provided limited and non-binding comments on the manuscript. The study team held 2 meetings with a technical advisory group, specifically the 28th of September 2010 and 12–13 of December 2011, to provide technical guidance for study design and review of preliminary findings.