An economic case for providing free access to antiretroviral therapy for HIV-positive people in South Australia
Kelly-Jean Heymer A , Matthias Wentzlaff-Eggebert B , Elissa Mortimer B and David P. Wilson A C
+ Author Affiliations
- Author Affiliations
A National Centre in HIV Epidemiology and Clinical Research, Faculty of Medicine, The University of New South Wales, Sydney, NSW 2010, Australia.
B Communicable Disease Control Branch, Department of Health, Adelaide, SA 5000, Australia.
C Corresponding author. Email: dwilson@unsw.edu.au
Sexual Health 9(3) 220-226 https://doi.org/10.1071/SH10148
Submitted: 27 November 2010 Accepted: 11 July 2011 Published: 24 August 2011
Abstract
Background: As financial constraints can be a barrier to accessing HIV antiretroviral therapy (ART), we argue for the removal of copayment requirements from HIV medications in South Australia. Methods: Using a simple mathematical model informed by available behavioural and biological data and reflecting the HIV epidemiology in South Australia, we calculated the expected number of new HIV transmissions caused by persons who are not currently on ART compared with transmissions for people on ART. The extra financial investment required to cover the copayments to prevent an HIV infection was compared with the treatment costs saved due to averting HIV infections. Results: It was estimated that one HIV infection is prevented per year for every 31.4 persons (median, 24.0–42.7 interquartile range (IQR)) who receive treatment. By considering the incremental change in costs and outcomes of a change in program from the current status quo, it would cost the health sector $17 860 per infection averted (median, $13 651–24 287 IQR) if ART is provided as a three-dose, three-drug combination without requirements for user-pay copayments. Conclusions: The costs of removing copayment fees for ART are less than the costs of treating extra HIV infections that would result under current conditions. Removing the copayment requirement for HIV medication would be cost-effective from a governmental perspective.
Additional keywords: cost-effectiveness, epidemiology, mathematical model, subsidy.
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