e0210497. Types of antiretroviral drug Antiretroviral therapy involves taking a combination of drugs each day. Micro-costing may be used in either top-down or bottom-up costing, depending on the level of detail and precision required. drugs. Only 42 (5%) of 1,047 records included in our full-text review reported primary cost data on HIV interventions in South Africa, with 71% of included papers covering ART. The crazy system exists because until very recently, there has been virtually no price competition in H.I.V. https://doi.org/10.1371/journal.pone.0210497.s001, https://doi.org/10.1371/journal.pone.0210497.s002, https://doi.org/10.1371/journal.pone.0210497.s003, https://doi.org/10.1371/journal.pone.0210497.s004, https://doi.org/10.1371/journal.pone.0210497.s005. But even we have limits to what we can do — because of spending on drugs.”. In economic analyses of HIV interventions, South Africa is often used as a case in point, due to the availability of good epidemiological and programme data and the global relevance of its epidemic. Cost categories included varied between intervention areas and perspectives. It should be borne in mind that the purpose of this paper is to summrise potential sources of cost data rather than every sub-aspect of our own or other analysts’ cost analyses. drugs. Finally, we collected which cost categories had been reported as having been included in the cost analysis (costs of antiretroviral and any other drugs; laboratory, radiology, staff, consumable, overhead, capital, and transportation costs). It will exclude Atripla because there’s now another drug that is essentially identical and costs 40 percent less. Most important are the distorted incentives for patients. Formal analysis, In our review we were able to find literature detailing the results of primary cost analyses for five out of the 11 intervention categories included in the Investment Case, including for most of the HCT technical efficiency factors. Data entries from one researcher were checked by another researcher working independently, and discrepancies resolved by reference to the original paper. We want to make sure everybody continues to have access to prescription drugs and services.”. Roles In an effort to correct for outdated costs, those modelled analyses tended to inflate primary cost data over many years using general inflation indices such as the consumer price index, instead of sourcing and using more recent input prices for salaries, drug costs, etc, which skewed resulting estimates considerably, often upwards. For more information about PLOS Subject Areas, click New high-quality antiretroviral therapy to be launched in South Africa, Kenya and over 90 low- and middle-income countries at reduced price Q&A Negotiated pricing agreements have lowered costs and will improve access to quality treatment for people living with HIV. South Africa (SA) may be able to provide antiretroviral therapy (ART) to several million more people with HIV by 2019, using the current drug budget. The results of both the literature review and the cost calculation exercise are presented in both ZAR and US dollars (USD), using the 2017/18 period average exchange rate of 1 USD = 13.32 South African Rand. In this method, the relationship between inputs and outputs (in this case, services rendered) is even harder to establish, as invoices might have not been paid on time and the charges paid could have been higher than the actual cost of inputs. For those interventions costed based on ingredients (rather than on literature or expenditure data), the cost per ingredient was the same across all interventions for which we used this ingredient- eg, for every intervention that required a primary healthcare nurse’s time, a minute of that nurse’s time costs the same. But if a patient has commercial insurance, they can bill the insurer at commercial prices. In the United States, many people with H.I.V. In the United States, pharmaceutical companies have built a system which supports high costs for H.I.V. It’s also good for everyone else: If people couldn’t afford their meds, we’d have many more deaths, huge hospital bills and an uncontrollable H.I.V. Project administration, More than 25 million people in the region are HIV positive, out of a total of 36 million worldwide, yet only a few thousand are being treated with antiretroviral drugs. Results of only 42 papers (5%) were included in the review. These resource costs are then summed to calculate the unit cost of the intervention. Steve Cohen’s time on this study was funded by the South African National AIDS Council (SANAC). A young woman who is taking H.I.V. For more information about PLOS Subject Areas, click So logic says it must cost less than $75. The agreement‚ negotiated with international organisations and agencies‚ meant the fixed-dose combination treatment will cost about $75 (about R991) per person a year. regimen will have no co-pay or co-insurance costs, and can get $500 in gift cards to use for other health care expenses. Other specified cost items not attributable to these categories comprised nutritional support or supplements [35,36], communication costs [37], the costs of end of life care [34], field materials [38] and start-up costs [39], bank and interest charges [40] and insurance costs [41]. That’s not only way below countries like Britain and France; it’s worse than Zimbabwe, Kenya and Malawi. “Lower cost” is relative — obviously, these prices are pretty far from $75. The authors propose that South Africa could have started an ARV treatment program in 2000, covering not more than 5% of persons who needed therapy but ramping up the coverage as drugs … Because the analysis optimised interventions and intervention coverage based on cost effectiveness, the cost of services was a central input into the analysis; at the same time, the analytical framework mandated that even though interventions could be excluded if there was no evidence as to their effectiveness, they could not be excluded if data on their cost was missing, leaving us with the task of establishing the cost of each of the interventions included in the Investment Case. PC: Personal communication; “From ingredients”: For more details regarding the quantity and prices of ingredients, please see S4 Table. Only 5% of the papers on HIV interventions that used the term “cost” or “economics” as well as “South Africa” in the text reported the results of a primary cost analysis. This method was used for the cost of male medical circumcision and for the three social behaviour change communication campaigns included in the analysis. Validation, For example, a commonly cited cost source is one of the very early costs of ART in an NGO-run programme years before the public-sector roll-out [9]. Monthly Average Prices of Commonly Used Antiretroviral Drugs; ARV Drug (Generic and Brand Names) Strength, Formulation Tablets, Capsules, or mLs per Month WAC (Monthly) b AWP (Monthly) b FUL (As of Oct. 31, 2019) c; NRTIs: Abacavir: Generic; 300 mg tablet: 60 tablets: $150 to $482: $502 to $603: $43: Ziagen; 300 mg tablet: 60 tablets: $559: $670: Emtricitabine: Emtriva We searched Pubmed for publications on the cost of each of the interventions, using a combination of MeSH and manually set search terms describing the intervention as well combinations of “economics”, “cost”, “cost analysis”, “costing”, “financial”, “budget” or “resource use”, at the level of title or abstract, as well as “South Africa” at the level of the text. The world is amazing have designed cost of antiretroviral drugs in africa system which supports rigorous reporting about responses to problems! 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