The cost-effectiveness of Antiretroviral Treatment in Khayelitsha, South Africa - a primary data analysis

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dc.contributor.authorCleary, Susanen_ZA
dc.contributor.authorMcIntyre, Dien_ZA
dc.contributor.authorBoulle, Andrewen_ZA
dc.date.accessioned2015-10-12T10:54:10Z
dc.date.available2015-10-12T10:54:10Z
dc.date.issued2006en_ZA
dc.description.abstractBACKGROUND:Given the size of the HIV epidemic in South Africa and other developing countries, scaling up antiretroviral treatment (ART) represents one of the key public health challenges of the next decade. Appropriate priority setting and budgeting can be assisted by economic data on the costs and cost-effectiveness of ART. The objectives of this research were therefore to estimate HIV healthcare utilisation, the unit costs of HIV services and the cost per life year (LY) and quality adjusted life year (QALY) gained of HIV treatment interventions from a provider's perspective. METHODS: Data on service utilisation, outcomes and costs were collected in the Western Cape Province of South Africa. Utilisation of a full range of HIV healthcare services was estimated from 1,729 patients in the Khayelitsha cohort (1,146 No-ART patient-years, 2,229 ART patient-years) using a before and after study design. Full economic costs of HIV-related services were calculated and were complemented by appropriate secondary data. ART effects (deaths, therapy discontinuation and switching to second-line) were from the same 1,729 patients followed for a maximum of 4 years on ART. No-ART outcomes were estimated from a local natural history cohort. Health-related quality of life was assessed on a sub-sample of 95 patients. Markov modelling was used to calculate lifetime costs, LYs and QALYs and uncertainty was assessed through probabilistic sensitivity analysis on all utilisation and outcome variables. An alternative scenario was constructed to enhance generalizability. RESULTS: Discounted lifetime costs for No-ART and ART were US$2,743 and US$9,435 over 2 and 8 QALYs respectively. The incremental cost-effectiveness ratio through the use of ART versus No-ART was US$1,102 (95% CI 1,043-1,210) per QALY and US$984 (95% CI 913-1,078) per life year gained. In an alternative scenario where adjustments were made across cost, outcome and utilisation parameters, costs and outcomes were lower, but the ICER was similar. CONCLUSION: Decisions to scale-up ART across sub-Saharan Africa have been made in the absence of incremental lifetime cost and cost-effectiveness data which seriously limits attempts to secure funds at the global level for HIV treatment or to set priorities at the country level. This article presents baseline cost-effectiveness data from one of the longest running public healthcare antiretroviral treatment programmes in Africa that could assist in enhancing efficient resource allocation and equitable access to HIV treatment.en_ZA
dc.identifier.apacitationCleary, S., McIntyre, D., & Boulle, A. (2006). The cost-effectiveness of Antiretroviral Treatment in Khayelitsha, South Africa - a primary data analysis. <i>Cost Effectiveness and Resource Allocation</i>, http://hdl.handle.net/11427/14177en_ZA
dc.identifier.chicagocitationCleary, Susan, Di McIntyre, and Andrew Boulle "The cost-effectiveness of Antiretroviral Treatment in Khayelitsha, South Africa - a primary data analysis." <i>Cost Effectiveness and Resource Allocation</i> (2006) http://hdl.handle.net/11427/14177en_ZA
dc.identifier.citationCleary, S. M., McIntyre, D., & Boulle, A. M. (2006). The cost-effectiveness of antiretroviral treatment in Khayelitsha, South Africa–a primary data analysis. Cost effectiveness and resource allocation, 4(1), 20.en_ZA
dc.identifier.ris TY - Journal Article AU - Cleary, Susan AU - McIntyre, Di AU - Boulle, Andrew AB - BACKGROUND:Given the size of the HIV epidemic in South Africa and other developing countries, scaling up antiretroviral treatment (ART) represents one of the key public health challenges of the next decade. Appropriate priority setting and budgeting can be assisted by economic data on the costs and cost-effectiveness of ART. The objectives of this research were therefore to estimate HIV healthcare utilisation, the unit costs of HIV services and the cost per life year (LY) and quality adjusted life year (QALY) gained of HIV treatment interventions from a provider's perspective. METHODS: Data on service utilisation, outcomes and costs were collected in the Western Cape Province of South Africa. Utilisation of a full range of HIV healthcare services was estimated from 1,729 patients in the Khayelitsha cohort (1,146 No-ART patient-years, 2,229 ART patient-years) using a before and after study design. Full economic costs of HIV-related services were calculated and were complemented by appropriate secondary data. ART effects (deaths, therapy discontinuation and switching to second-line) were from the same 1,729 patients followed for a maximum of 4 years on ART. No-ART outcomes were estimated from a local natural history cohort. Health-related quality of life was assessed on a sub-sample of 95 patients. Markov modelling was used to calculate lifetime costs, LYs and QALYs and uncertainty was assessed through probabilistic sensitivity analysis on all utilisation and outcome variables. An alternative scenario was constructed to enhance generalizability. RESULTS: Discounted lifetime costs for No-ART and ART were US$2,743 and US$9,435 over 2 and 8 QALYs respectively. The incremental cost-effectiveness ratio through the use of ART versus No-ART was US$1,102 (95% CI 1,043-1,210) per QALY and US$984 (95% CI 913-1,078) per life year gained. In an alternative scenario where adjustments were made across cost, outcome and utilisation parameters, costs and outcomes were lower, but the ICER was similar. CONCLUSION: Decisions to scale-up ART across sub-Saharan Africa have been made in the absence of incremental lifetime cost and cost-effectiveness data which seriously limits attempts to secure funds at the global level for HIV treatment or to set priorities at the country level. This article presents baseline cost-effectiveness data from one of the longest running public healthcare antiretroviral treatment programmes in Africa that could assist in enhancing efficient resource allocation and equitable access to HIV treatment. DA - 2006 DB - OpenUCT DO - 10.1186/1478-7547-4-20 DP - University of Cape Town J1 - Cost Effectiveness and Resource Allocation LK - https://open.uct.ac.za PB - University of Cape Town PY - 2006 T1 - The cost-effectiveness of Antiretroviral Treatment in Khayelitsha, South Africa - a primary data analysis TI - The cost-effectiveness of Antiretroviral Treatment in Khayelitsha, South Africa - a primary data analysis UR - http://hdl.handle.net/11427/14177 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14177
dc.identifier.urihttp://dx.doi.org/10.1186/1478-7547-4-20
dc.identifier.vancouvercitationCleary S, McIntyre D, Boulle A. The cost-effectiveness of Antiretroviral Treatment in Khayelitsha, South Africa - a primary data analysis. Cost Effectiveness and Resource Allocation. 2006; http://hdl.handle.net/11427/14177.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentHealth Economics Uniten_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceCost Effectiveness and Resource Allocationen_ZA
dc.source.urihttp://www.resource-allocation.comen_ZA
dc.subject.otherAntiretroviral Treatment costsen_ZA
dc.titleThe cost-effectiveness of Antiretroviral Treatment in Khayelitsha, South Africa - a primary data analysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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