8th International AIDS Conference Amsterdam, Netherlands — July 19-24, 1992

Int Conf AIDS 1992 Jul 19-24; 8:We51 (abstract no. WeC 1038)
Cameron C, Tarantola D; Global AIDS Policy Coalition, International AIDS Center, Harvard School of Public Health, Boston, MA.

OBJECTIVE: To estimate the global inpatient and outpatient costs of AIDS care in 1990. To compare this cost with per capita gross national product (GNP).

METHODS: A review of the literature was undertaken to gauge the annual inpatient and outpatient costs per AIDS case. A survey was conducted in 37 countries which provided government expenditures on care of HIV-infected persons and those with AIDS. Follow-up with health personnel and researchers in a subset of countries completed the information collection exercise. In industrialized countries, literature and contacts provided estimates for costs. In developing countries where cost data existed, costs were extrapolated to the global level by multiplying annual costs per AIDS patient times the estimated number of AIDS cases per country. Where studies were not available, either best judgment or, as a surrogate measure, per capita GNP were used for costs. Two scenarios were examined. First, a low estimate where 70% of AIDS patients in non-OECD countries and 100% in OECD countries received care. A low estimate for the number of global AIDS cases was used. Second, a high estimate where 100% of all AIDS patients received care. A high estimate was used for the number of global AIDS cases.

RESULTS: The low scenario shows total costs of $2.6 billion to care for the almost 200,000 persons with AIDS; 70% of whom in non-OECD countries were assumed to have access to formal medical care. The high cost case shows estimated costs of $3.5 billion to care for almost 330,000 persons, 100% of whom were assumed to have access to care. While 30-40% of cases are in OECD countries, they account for 84% to over 90% of all costs. Approximately half of all AIDS cases are in Africa, yet they represent only between 1.5% to 2% of global costs. The cost of treatment for one year for one person ranged from less than US$400 in Africa to between $26,000 and US$32,000 in OECD countries. Typically, medical care in OECD countries includes AZT. In all countries examined, the majority of costs were for inpatient care. For example, inpatient care represented 75% and 90% of total annual care costs in the US and Rwanda, respectively. It was also concluded that per capita GNP was a reasonable surrogate for annual inpatient and outpatient care costs for persons with AIDS. Analysis of existing cost studies showed that per capita GNP was a better indicator for developing than for industrializing countries. For example, in Thailand and Rwanda, annual care costs were estimated at 83% and 112% of per capita GNP, respectively. However, in Switzerland and the US, the ratios were estimated at 122% and 153%, respectively. In most cases, annual care costs were at least equal to per capita GNP. This supports the use of per capita GNP for rapidly estimating annual national costs of care for AIDS patients.

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