$19 billion triple therapy bill for South Africa, even with price cuts

Keith Alcorn
Estimated reading time 3 minutes
This article is more than 24 years old.

Triple therapy for a quarter of HIV-infected South Africans would cost $19 billion over five years, even taking into account drastic price cuts hinted at by some manufacturers, according to a projection published today in The Lancet.

However, provision of short-course prophylaxis for 25% of HIV-positive pregnant women would cost only $1.8 million and would prevent approximately 30,000 HIV infections over a five year period. This level of intervention was modelled in order to reflect the difficulties of implementing treatment given the current health care infrastructure, and the fact that only 50% of HIV-positive women actually return to receive their diagnosis after consenting to a test.

More extensive uptake of prophylaxis (assumed to be short course nevirapine in the cost model) led to corresponding reductions in the number of HIV-positive infants and cumulative AIDS cases.

Glossary

perinatal

Relating to the period starting a few weeks before birth and including the birth and a few weeks after birth.

perinatal

Relating to the period around the time of birth. Perinatal transmission is when HIV is passed on during pregnancy, childbirth or breastfeeding. People with perinatally-acquired HIV have been living with HIV since birth or infancy.

If 75% of pregnant women with HIV receive prophylaxis, the number of HIV-infected infants would fall by 83,000, and if prophylaxis could be implemented universally for all women who might give birth between 2000 and 2005, the number of HIV-positive infants would fall by 110,000, but there would still be 166,000 HIV-positive infant births.

Whilst triple therapy for a quarter of HIV-infected South Africans would prevent an estimated 431,000 new AIDS cases between 200 and 2005, it would eat up approximately 12.5% of South African health care spending. However, the model does not take into account any knock-on effects on the rate of HIV transmission

Antiretroviral intervention

Cumulative AIDS cases 2000-2005

Cumulative HIV-positive infants born

Total drug cost

Do nothing

2.3 million

276,000

Nothing

25% prophylaxis

2.27 million

248,000

$1.8 million

Universal use of prophylaxis

2.17 million

166,000

$52 million

Triple therapy for 25% of adults

1.87 million

276,000

$19 billion

Key assumptions of the model

  • 95% of adults develop AIDS within 6 years of infection

  • 50% of infants develop AIDS within 2 years of infection

  • Median reduction in perinatal transmission of 40%

  • Life extended by median of 6 years by use of triple combination therapy

  • Median cost of antiretroviral prophylaxis of $8

  • Estimated cost of triple therapy: $2900

  • Baseline prevalence of HIV: 12%, prevalence by 2005, 15%

  • Perinatal transmission rate among breastfeeding women: 30%

Reference

Wood E et al. Extent to which low-level use of antiretroviral treatment could curb the AIDS epidemic in sub-Saharan Africa. The Lancet 355: 2095-2100, 2000.

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