The cost of treatment and care for people living with HIV Infection

Economics

The cost of treatment and care for people living with HIV Infection

Increasing number of people living with HIV will require expanded access to health services. Countries need robust and contemporary strategic information on the cost of care to monitor and evaluate the effectiveness, efficiency, equity, and acceptability of services. Published HIV cost literature from July 1999 to December 2008 was reviewed. Articles were identified using specific databases and scored, based on explicit criteria relating to the services covered, utilization data, cost data used and quality of the study. One hundred and fifteen articles were identified, 47% came from North America, 29% from Europe, 17% from Africa and 8% from Asia; no studies from Latin America could be identified. The mean score across all studies was 33.7 out of a maximum of 64, with a median of 34 and a range of 11–51. Mean score did not change significantly over time (Pearson’s R8¼0.3; P>0.05). Great variation was observed in the methods used to estimate cost data across the studies identified, including range of services, patients covered and outcomes costed. Progress in the quantity and quality of studies published since 1999 has been limited. More consistent costing methods and more comprehensive coverage – both by country and level of care – are needed in order for policymakers and other stakeholders to be able to optimally monitor and evaluate the cost and cost–effectiveness of country services for HIV treatment and care, especially as population costs are likely to increase with more people living with HIV on antiretroviral therapy.

As this systematic review reveals, surprisingly few peer-reviewed costing studies have been published over a decade (n=115) of which 76% were conducted in North America or Europe. This is despite the steadily increasing number of people on antiretroviral treatment in Africa and Asia. Although this review found that comparisons are complicated by differences in sources of information, adjustments made, and the variety of methodologies used, costing studies can be very useful nonetheless at the national and district levels. Financial information is a key component of the evidence that policymakers need to consider when planning, implementing, and reviewing treatment programmes. Clearly, adoption of the use of standardized costing methodologies would make cost estimates more comparable but more importantly, adequate funding to conduct well-designed costing studies can help ensure that local decisions are informed by the efficiencies and scope for improvement that such studies can reveal.