The cost of antiretroviral drugs (ARVs) amounts to only one third of the costs incurred in treating HIV-positive people with antiretroviral therapy in South Africa, researchers reported last week at the 2006 Implementers Meeting of the President’s Emergency Plan for AIDS Relief in Durban, South Africa.
Global advocacy over the past six years has strongly emphasised the need to reduce the price of antiretroviral drugs in order to widen access to treatment in resource-limited settings.
However there has been little analysis of the extent to which other costs contribute to the total cost of care, particularly in contexts where drug costs have already been driven down by voluntary licensing and competition.
Neil Martinson and colleagues from the University of the Witwatersrand and Harvard Medical School conducted an in-depth health services utilisation study in a random sample of 100 patients due to start antiretroviral therapy at their clinic in 2004-2005, and a total cost estimation for the treatment of 980 patients at the Soweto clinic.
The patients were typical of those currently eligible to start antiretroviral therapy in South Africa. The median baseline CD4 cell count was 109 cells/mm3, the median viral load was 61,500 copies/ml, and 75% were women.
Cost information was gathered by analysis of invoices and by interviews with programme staff.
Data were presented in two ways: as a proportion of total costs, and as costs in the month before, the month after and during the month of initiation of antiretroviral treatment.
Monthly average costs
| Month before | Month started | Month after | |
| Laboratory | $54 | $86 | $8 |
| Non-ARV drug costs | $ 6.90 | $ 6 | $5.30 |
| ARV drug costs | 0 | $35 | $70 |
| Other (personnel, facility) | $46 | $46 | $46 |
| Total | $106.90 | $173 | $129.30 |
Proportional contributions to cost
| Personnel | 33% |
| Antiretrovirals | 31% |
| Laboratory | 18% |
| Clinic costs | 9% |
| Non-antiretroviral drug costs | 3% |
| Other | 5% |
The authors say that theirs is the first study providing data on treatment costs within a PEPFAR-funded programme, and that further reductions in the costs of antiretrovirals and laboratory tests, or less utlilisation of laboratory services, would have a major impact on the total costs of the programme.
The average monthly cost of the programme at this facility was $91,500 a month and the average antiretroviral costs was $102 per month.
Martinson N et al. Outpatient provider costs of treating adults with ARVs in Soweto. The 2006 HIV/AIDS Implementers Meeting of the President’s Emergency Plan for AIDS Relief, Durban, South Africa, abstract 502.