Marvin Joseph/The Washington Post, via Getty Images, is kicking an H.I.V. It started with a long list of interventions proposed during a stakeholder workshop which was then subjected to a rigorous review of the evidence regarding each intervention’s effectiveness. South Africa has begun rolling out a state-of-the-art antiretroviral drug in a “game-changing” bid to drastically reduce the number of people living with HIV. medicines are a big part of that. The fact that there is also often good local cost data available has however received less attention. Along with the inconvenience of multiple-pill regimens, this is a big reason generics aren’t much used. So patients could end up paying more out of pocket for a $1,000 generic than for a $30,000 brand-name drug. “There’s a complex patchwork in place. But it’s hard for them to refuse to cover a recommended drug, and they can pass their costs along in the form of higher premiums. Writing – review & editing, Affiliation Finally, for selected interventions for which no published data on either unit cost or ingredients was available, we used information from budgets or expenditure records. Yes The United States is infamous for its high cost of health care — and H.I.V. Next week: I’ll report on how some places have been able to keep H.I.V. The same is true for Mylan’s three-drug combos. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Financial costs only include accounting (or monetary) costs, whereas economic costs include both accounting costs and opportunity (or non-monetary) costs, for example volunteers’ time or donated goods. Sub-Saharan Africa is bound to become the biggest user of antiretroviral drugs in the world, so it has to start preparing to use them now, a conference of AIDS experts was told last week. These resource costs are then summed to calculate the unit cost of the intervention. Why now? has just made its debut in Africa. The difference? The agreement‚ negotiated with international organisations and agencies‚ meant the fixed-dose combination treatment will cost about $75 (about R991) per person a year. For this, we first conducted a systematic review of available published data on the costs of the selected interventions, based on primary cost analyses published between 2000 and 2016 that described a mode of delivery of the intervention that was relevant to South Africa, with or without a comparator population or intervention, and as part of any type of economic analysis, including cost and cost-effectiveness or cost-utility analyses. We included papers published in any language between 01/01/2000 and 31/12/2016 (see S1 Table for the full list of search terms). No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pone.0210497, https://ghcosting.org/pages/data/ucsr/app/index, http://dx.doi.org/10.1371/journal.pone.0168118, http://dx.doi.org/10.1371/journal.pone.0148546, http://www.statssa.gov.za/?page_id=1854&PPN=P0141, http://dx.doi.org/10.1371/journal.pone.0135048. More work should also be directed to generate additional estimates of the cost of technical efficiency factors, including adherence interventions and different modalities of delivering HIV counselling and testing services, especially given the heightened demand for these factors. The fact that antiretroviral medicines were priced beyond the reach of most people who needed them in Africa had long been an international concern: at the International AIDS Conference in Stockholm in 1988 there was debate about how to ensure people in the developing world could access the treatment of that time - zidovudine monotherapy - which was marketed at a price of US$8000 per year . Data Availability: All relevant data are within the paper and its Supporting Information files. We identified 1,047 papers through the search and another 7 references either mentioned in these papers or suggested by experts (Table 1). https://doi.org/10.1371/journal.pone.0210497.s001, https://doi.org/10.1371/journal.pone.0210497.s002, https://doi.org/10.1371/journal.pone.0210497.s003, https://doi.org/10.1371/journal.pone.0210497.s004, https://doi.org/10.1371/journal.pone.0210497.s005. Labour costs, which are often the largest contributor to the cost of an intervention, have generally increased at a higher rate than inflation- for example, the introduction of Occupational Specific Dispensation in 2007 marked a structural shift in health worker remuneration. Results of only 42 papers (5%) were included in the review. Discover a faster, simpler path to publishing in a high-quality journal. AIDS triple-combination therapy, which costs US$ 10 000 per patient per year in industrialized countries, can now be obtained from Indian generic drugs company, Cipla, for less than US$ 200 per year. Center for Global Health and Development, Boston University, Boston, Massachusetts, United States of America, Roles For the results of our own ingredient cost analysis, however, we added the details of the exact ingredients, quantities and unit prices included for each intervention and technical efficiency factor in S4 Table in order to allow other analysts to easily update our estimates to their settings and future prices. 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. Across all types of unit cost, we used the same public-sector input costs to establish a common frame of reference. At Mylan, he negotiated the agreement to supply the $75 therapy in low-income countries. Mr. Horn believes things are changing. Ms. Rosenberg is a co-founder of the Solutions Journalism Network, which supports rigorous reporting about responses to social problems. For those without private insurance, Medicare or Medicaid, the Ryan White AIDS Drug Assistance Program steps in. Anil Soni, the head of global infectious diseases for Mylan, said that if generics and lower-cost H.I.V. Does It Matter? Since we do not attempt to synthesize the evidence further, for example by creating a mean cost and cost range of a single intervention from several such reported estimates, we do not think that our analysis is subject to reporting bias. Despite HIV interventions making up a large proportion of the health interventions in South Africa for which cost estimates are available [42], and despite a large number of reviews showing that South Africa is home to more cost estimates for HIV interventions than any other low- and middle-income country [43–46], our search yielded limited results. “Whenever I hear that, I pretty much have a seizure,” said Dr. Daskalakis. Not enough. This does not alter our adherence to PLOS ONE policies on sharing data and materials. here. Formal analysis, We reviewed available cost data as part of the South African HIV Investment Case, a modelling exercise to inform the optimal use of financial resources for the country’s HIV programme. Is the Subject Area "Economic analysis" applicable to this article? We systematically reviewed publication databases for published cost data covering a large range of HIV interventions and summarised relevant unit costs (cost per person receiving a service) for each. But insulating patients from costs has greatly reduced patient pressure for lower prices. A large number of modelled economic analyses of HIV interventions in South Africa use as inputs the same, often outdated, cost analyses, without reference to additional literature review. Instead, a large number of modelled economic analyses of HIV interventions in South Africa which made reference to the same, often outdated, cost analyses, with no reference to any additional review of other literature. Beginning this fall, it will encourage patients it covers to choose a less expensive H.I.V. e0210497. Similarly, drug costs, also a significant contributor to total costs, do not increase each year with inflation as the costs are negotiated through a tender process and may be fixed for a number of years, and in the past the prices tended to decrease as a result of tender negotiations. therapy. “They really do help to subsidize a lot of H.I.V. care,” he said. In its My ScriptRewards program, patients who choose the cheaper H.I.V. Writing – review & editing, Affiliation For these reasons we would advise caution in applying straight-line inflation adjustments to the costs of health interventions in South Africa over a number of years. The timing of when to start therapy has continued to be a core controversy within the medical community, though recent studies have led to more clarity. No, Is the Subject Area "HIV epidemiology" applicable to this article? But even we have limits to what we can do — because of spending on drugs.”. Drugs can’t solve that. We then included into the Investment Case analysis those unit costs that were either, an update on such literature, or, if no literature was available, on data from recent expenditure analyses of relevant providers. She’s talking about new drugs from Mylan — the generic manufacturer that achieved infamy for the $600 EpiPen in 2016. The remaining interventions had to be costed using an ingredients-based approach, which is more prone to over- or underestimation than the detailed analysis of actual resources used in a bottom-up cost analysis. Few analyses however use locally relevant cost data. Impact of antiretroviral drugs in pregnant women and their children in Africa: HIV resistance and treatment outcomes J Infect Dis . 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. per patient year) of a sample of service recipients during the intervention, and multiplying the resource use by the cost of each resource from the same period as the resources were used. Project administration, medicine, Atripla, off its list of covered drugs. Writing – review & editing, Affiliations What does it cost to make each year’s supply of that $39,000 therapy? Data curation, For example: Medicare is not allowed to negotiate with drug companies on price — although 92 percent of Americans think it should. drugs. In the United States, pharmaceutical companies have built a system which supports high costs for H.I.V. drugs. We were able to find estimates of the cost of 55% of the services in the literature, almost all of which we further updated to represent the most recent South African input prices. medication at home. This year the company brought out three new H.I.V. For more information, we suggest to contact either the authors of the papers we reference or, if more information on the ingredients cost summarised in S4 Table is required, the corresponding author of this paper. Insulating patients from costs has greatly reduced patient pressure for lower prices to control costs of papers 4! Eastern and Southern Africa, Western African countries are generally facing relatively low HIV levels. If patients have high out-of-pocket costs, such as co-pays and co-insurances, makers brand-name... 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