Important note: Information in this article was accurate in July 2002. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; July 1, 2002
Michael Greer, Senior Medical Writer
"African governments face difficult choices in striking the right balance between prevention, treatment, and care, all of which are necessary to deal comprehensively with the epidemic," according to Andrew Creese and colleagues working with the World Health Organization in Geneva, Switzerland, the University of Copenhagen in Denmark, and the London School of Hygiene and Tropical Medicine in the United Kingdom. "Reductions in drug prices have raised the priority of treatment, though treatment access is restricted."
Despite falling drug prices, programs focusing on prevention or tuberculosis treatment remain far more cost-effective than antiretroviral therapy, Creese and coauthors argued.
The authors reviewed data from more than 20 studies containing information about the cost and efficacy of African anti-HIV programs. Collectively, these studies revealed that each disability-adjusted life-year (DALY) gained by antiretroviral therapy for adults cost several hundred American dollars, according to the report.
By contrast, giving condoms to patients treated for sexually transmitted diseases extended lives at a cost of only US$1 per DALY. Moreover, each HIV infection prevented in this manner cost only US$11, study data showed. Programs offering tuberculosis therapy or voluntary HIV testing were also cost-effective with price tags of less than $75 per DALY gained.
Although antiretrovirals were not cost-effective for adult treatment, short regimens of zidovudine or nevirapine were far more cost-effective for preventing vertical HIV transmission than formula feeding programs, which cost several thousand dollars for every infection prevented (Cost-effectiveness of HIV/AIDS interventions in Africa: A systematic review of the evidence, Lancet 2002 May 11;359(9318):1635-43.
"A strong economic case exists for prioritisation of preventive interventions and tuberculosis treatment," Creese and colleagues concluded.
The corresponding author for this report is Andrew Creese, World Health Organization, Essential Drugs and Medicine Policy Dept., CH-1211 Geneva, Switzerland. E-mail: creesea@who.ch.
Key points reported in this study include:
This article was prepared by AIDS Weekly editors from staff and other reports.
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