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The financial implications of the 2010 WHO recommendations for ART in resource-limited settings

The financial implications of the 2010 WHO recommendations for ART in resource-limited settings. Lori Bollinger, John Stover and Carlos Avila Vienna International AIDS Conference 21 July 2010. Background. New antiretroviral therapy (ART) guidelines published in July 2010

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The financial implications of the 2010 WHO recommendations for ART in resource-limited settings

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  1. The financial implications of the 2010 WHO recommendations for ART in resource-limited settings Lori Bollinger, John Stover and Carlos Avila Vienna International AIDS Conference 21 July 2010

  2. Background • New antiretroviral therapy (ART) guidelines published in July 2010 • Developed during 2009 through a consultative process led by World Health Organization • Part of process was to evaluate financial implications of proposed guidelines • Model developed to perform this evaluation • Switching eligibility criterion to CD4<350 • Switching ARV regimen (away from d4T)

  3. Methodology • Model tracks the HIV+ population by CD4 count • Results for impact on number needing ART are presented separately • Increases ART need by about 50% • Two ARV regimen scenarios presented here • “Fast” phase-out of d4T: 24% of total by 2012 • “Slow” phase-out of d4T: 38% of total by 2012 • Costs include: • ARV costs per patient per year • Laboratory costs (US$180/pppy) • Service delivery costs • Outreach and testing costs

  4. ARV costs (US$)

  5. Service delivery costs combine median number of IPD/OPV with WHO-CHOICE country-specific cost per visit

  6. Outreach and testing costs • Patients with symptoms of HIV (none) • STI patients (none) • TB patients (none) • Pregnant women (none – assumed in PMTCT costs) • Other health system contacts (US$16) • Sex workers (US$1 – HIV test cost only) • MSM (US$1 – HIV test cost only) • Injecting drug users (US$1 – HIV test cost only) • VCT (US$16) • General population (US$23)

  7. Scenarios for results (again) • Switch eligibility criteria to CD4<350 • Overall ART need increases by about 50% • Two scenarios: • Fast phase-out of d4T – 24% of total by 2012 • Slow phase-out of d4T – 38% of total by 2012 • Reach 80% coverage of those needing ART by 2015

  8. Results: Total resources required for ART (2009 US$)

  9. Results: Breakdown of cumulative resources required 2010-2015

  10. Results: Cost-effectiveness implications

  11. Summary and Conclusions • Increasing the eligibility criterion and phasing out d4T results in annual ART costs ranging between US$3.5 billion in 2010 and US$9.5 billion by 2015 • Once criterion changes, costs are split in thirds: 1/3 to ARVs, 1/3 to labs and 1/3 split evenly between service delivery and testing • Testing costs are significantly lower before change • Cost per person year on ART is US$800, while the cost per death averted is about US$10,000 • Implementing a faster phase-out of d4T does not have a large impact on overall costs

  12. The financial implications of the 2010 WHO recommendations for ART in resource-limited settings Lori Bollinger, John Stover and Carlos Avila Vienna International AIDS Conference 21 July 2010

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