TRIPS, Public Health Systems and Free Access
Edited by Benjamin Coriat
Chapter 9: Cost-effectiveness of HIV Antiretroviral Therapies in Resource-limited Settings
9. Cost-eﬀectiveness of HIV antiretroviral therapies in resourcelimited settings Yazdan Yazdanpanah, Caroline E. Sloan and Kenneth A. Freedberg INTRODUCTION In the late 1990s and early 2000s, some argued that HIV funding in resource-limited settings should be devoted mainly to prevention and to some non-antiretroviral therapy (ART) treatment and care (Walgate, 2002; US Senate, 2003). This view was in part based on results of studies that showed that the cost of making combination ART available worldwide would be exceedingly high, and moreover that HIV prevention activities are likely to be substantially more cost-eﬀective than provision of ART (Hogg et al., 1998; Creese et al., 2002; Marseille et al., 2002). However, these studies did not evaluate whether the provision of ART itself was costeﬀective, and the comparisons with prevention activities were done without standardized methods. Providing ART in resource-limited settings has, however, now become feasible, due to its dramatic survival beneﬁts, and the fact that ART eﬀicacy in these settings was found to be comparable to eﬀicacy in developed countries (Laurent et al., 2002, 2004; Weidle et al., 2002; Orrell et al., 2003). Reduced drug costs and the dramatic rise in global funding for HIV/AIDS have had the biggest impact on the availability of care (Walgate, 2002; US Senate, 2003; Levi et al., 2002). Results of short-term cost studies from countries such as Brazil showed that treatment of patients with advanced AIDS, in the ﬁrst several years of ART availability, was associated with important cost trade-o...
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