For every 1,000 patient-years of PEPFAR-supported HIV treatment provided, 228 fewer HIV patients die, 449 fewer children become orphans, 61 fewer sexual HIV transmissions occur and 26 fewer “vertical” transmissions (e.g. mother-to-child) occur.
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory Board heard the new PEPFAR ART Cost Model data from John Blanford, PhD, of the Centers for Disease Control and Prevention (CDC) in Washington, DC, on September 14.
PEPFAR developed the antiretroviral therapy (ART) cost model to estimate resource requirements for treatment scale up, utilizing data from the multi-country PEPFAR ART Costing Project Study and other PEPFAR-supported studies.
In his presentation “Estimating Health Impact and Costs of Treatment in PEPFAR-Supported Programs,” Blanford also discussed longer-term estimations of epidemic impact and costs of accelerated scale-up in light of the HPTN 052 study findings, which found that immediate treatment for HIV-infected persons reduces their chances of infecting their uninfected sexual partners by 96 percent.
Giving audience members a sneak peak at preliminary data from a model using Kenya as an example, Blanford said that accelerated treatment scale up in that population could reduce HIV incidence by 31 percent over five years, and the societal cost savings of averted deaths, illness, and infections would offset the cost of the treatment component by up to 58 percent in the same time. The priority groups that would receive the rapid expansion of ART in the model include patients known to be HIV infected who:
- have CD4 counts less than 500 cells/µl already on waiting lists for ART or in pre-ART care
- are pregnant and breastfeeding, regardless of CD4 cell count, for life
- have active tuberculosis (TB); or
- are known to be in serodiscordant couples, regardless of CD4 count.
Approximately 323,000 additional patients would be moved into treatment under this scale-up model. The annual number of new infections was estimated to drop from more than 120,000 in 2011 to approximately 85,000 in 2015. Although treatment resources initially would need to expand to cover the additional patients, the accelerated scenario would require fewer resources over time, and by 2020 would be nearly 1/3 less expensive than what is projected without the treatment acceleration intervention.
Blanford highlighted in his presentation that cost data under PEPFAR has been an evolving process. Earlier data showed that as ART access increased over time (between 2004 and 2009), the per-patient costs declined dramatically. In 2004, it cost more than $1,000 per patient supported on ART per year. By 2009, that had decreased to about $450 per patient, and more than 2.5 million patients were being supported. The number of patients currently being supported is almost 4 million. Although impressive, Blanford said they decided the data they had accumulated needed to evolve to more fully account for the societal impact of treatment – to include not only the direct benefit to the patient, but indirect benefits to society, such as averted secondary infections and orphanhood, and averted costs.
In related news, in a new article published in PLoS ONE, investigators from the Results for Development Institute, Harvard School of Public Health, the Global Fund, and Imperial College in the U.K., reached similar conclusions – that within 10 years of investment, the economic benefits of treatment will substantially offset and likely exceed program costs, in addition to the benefit of large health gains.
The researchers looked at 2009 ART prices and program costs to estimate that in order to maintain the 3.5 million patients currently on treatment in low- and middle-income countries until 2020, $14.2 billion is needed. “This investment is expected to save 18.5 million life-years and return $12 to $34 billion through increased labor productivity, averted orphan care, and deferred medical treatment for opportunistic infections and end-of-life care,” according to the article summary. “Under alternative assumptions regarding the labor productivity effects of HIV infection, AIDS disease, and ART, the monetary benefits range from 81 percent to 287 percent of program costs over the same period.”