The Commission on Macroeconomics and Health was established in January 2000 under the direction of the WHO Director-General to examine interrelations between investment in health, economic growth and poverty reduction. As part of the background analysis, researchers investigated the likely costs of scaling-up antiretroviral (ARV) treatment for HIV/AIDS.

The cost analysis included all countries in sub-Saharan Africa and every nation with a per capita GNP below $1200. Three major variables influenced the costs:

• the population in need
• change in coverage
• unit costs.

They also calculated additional infrastructure costs related to providing a package of care for HIV, including investment in health facilities and recruitment and training of new personnel.

It is estimated that less than one percent of all people currently living with HIV/AIDS and with access to health services receive ARVs. The researchers built costs on a baseline extrapolated from current available data for 2002 to produce three scenarios reflecting different coverage levels:

2007A - conservative estimates based on scaling-up within existing health system capacities to deliver ARVs to ten percent of patients with access to health services by 2007

2007B - cost estimates assuming substantial investment in current health systems to increase coverage to 45 percent of this group by 2007

2015 - costs consistent with long-term investments in delivery and infrastructure to provide ARV treatment for 65 percent of people living with HIV/AIDS by 2015.

The estimated total annual amount that would be required from 2002 to scale-up ARV treatment to these three levels would be US$ 0.8-1.2 billion, 4.2-5.8 billion and 6.8-9.2 billion, respectively. This analysis assumed that ARV would only be delivered in the context of strengthened clinical management of HIV-related illnesses. An additional US$ 6.8-7.1 billion would be required annually to provide this for 70 percent of patients by 2015.

The researchers considered both the drug and infrastructure costs that are required to deliver ARVs. Even if drug prices fall significantly, the financial barriers to implementing ARV are still almost insurmountable for the vast majority of low and middle-income countries, without substantial international support.

Source(s):
'Costs of scaling-up priority health interventions in low and selected middle income countries: methodology and estimates' by L. Kumaranayake, C. Kurowski and L. Conteh, Commission for Macroeconomics and Health, Working Group Five Discussion Paper No. 19 (2001)

id21 Research Highlight: 14 March 2002

Further Information:
Lilani Kumaranayake
Department of Public Health and Policy
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0)20 7927 2412
Fax: +44 (0)20 7637 5391
Contact the contributor: lilani.kumaranayake@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

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