Table A (as supplied by author). Resource use patterns and unit costs for HIV/AIDS interventions*

Intervention / Intervention component

Resource use

Volume

Unit costs (I$)**

Unit

Source

 

 

 

Afr-E

Sear-D

 

 

Mass media

 

 

 

 

 

Information, education and communication

Information leaflets

Distributed to 7% of population annually

0.30

per leaflet

(1)

 

TV emissions

13 emissions of each 5 minutes on national TV annually

2566

3275

per minute

(1)

 

Radio emissions

45 emissions of each 2.5 minutes on 5% of all radio stations in region annually

383

500

per minute

(1)

Voluntary counselling and testing

 

 

 

 

 

Test costs

Rapid test

1.25 per person tested

0.47

per test

(2)

Health centre costs

Outpatient visits

5 per person tested

4.98

2.97

per outpatient visit, 95% coverage

(3)

Training

Training of health workers

2 health workers per health centre receive two weeks training course plus annual refresher training

665

647

per trainee

(1)

 

 

 

 

 

 

 

Educating sex workers

 

 

 

 

 

 

Condom distribution

Condoms

Annual number of condoms based on number of sex acts per sex worker, condom use and waste

0.03

0.03

per condom

Assumption

Information, education and communication

Posters

1 per 100 sex workers annually

2.67

2.65

per poster

(1)

 

Information leaflets

1 per sex worker annually

0.30

per leaflet

(1)

Training

Training of social workers

Social workers receive two weeks training course plus annual refresher training. Number of social workers is estimated on the basis that each social worker covers 5 peer educators who reach each 20 sex workers

665

647

per trainee

(1)

 

 

 

 

 

 

 

School-based education

 

 

 

 

 

 

Training

Training of teachers

3 teachers per school receive two weeks training course plus annual refresher training

665

647

per trainee

(1)

 

 

 

 

 

 

 

 

 

Table A cont.

 

 

 

 

 

 

Intervention / Intervention component

Resource use

Volume

Unit costs (I$)**

Unit

Source

Treatment of sexually transmitted infections

 

 

 

 

 

Drug costs

Syphilis or chancroid

2.4 million IU benzathine benzyl penicillin (1 dose) and 500mg ciprofloxacin (6 doses) per patient

0.23

per treatment

(4)

 

HSV2

200mg acyclovir (35 doses) per patient

0.89

per treatment

(4)

 

Gonorrhoea or chlamydia

500mg ciprofloxacin (1 dose) / 100mg doxycycline (14 doses) per patient

0.10

per treatment

(4)

 

Trichomoniasis

Metronidazole, 2 g orally (1 dose) per patient

0.03

per treatment

(4)

Health centre costs

Outpatient visits

1.1§ per patient

4.98

2.97

per outpatient visit, 95% coverage

(3)

Training

Training of health workers

1 health worker per health centre receives two weeks training course plus annual refresher training

665

647

per trainee

(1)

Preventing mother-to-child transmission||

 

 

 

 

 

Drug costs

 

 

 

 

 

 

 

Infant: nevirapine

6 mg (1 dose) per infant treated

0.01

per treatment

(5)

 

Mother: nevirapine

200 mg (1 dose) per mother treated

0.13

per treatment

(5)

Health centre costs

Outpatient visits

1 per delivery

4.98

2.97

per outpatient visit, 95% coverage

(3)

Training

Training of health workers

1 health worker per health centre receives two weeks training course plus annual refresher training

665

647

per trainee

(1)

Antiretroviral therapy

 

 

 

 

 

Training costs (all antiretroviral therapies)

Training of health workers

Two health workers per health centre receive two weeks training course plus annual refresher training

665

647

per trainee

(1)

No intensive monitoring, first-line drugs only

 

 

 

 

 

Drug costs

First-line drugs only (d4T/3TC/NVP or ZDV/3TC/NVP)

20% of all patients change drug regimen because of toxicity

177.8

per treatment (on average)

(5)

 

Treatment for opportunistic infections

40% of all patients, requiring testing, 7-days hospitalization, and treatment

233

221

per treatment (on average)

(5)

Health centre costs

Outpatient visits

4, annually per patient

4.98

2.97

per outpatient visit, 95% coverage

(3)

 

 

 

 

 

 

 

Table A cont.

 

 

 

 

 

 

Intervention / Intervention component

Resource use

Volume

Unit costs (I$)**

Unit

Source

Antiretroviral therapy (cont.)

 

 

 

 

 

Intensive monitoring, first-line drugs only

 

 

 

 

 

Drug costs

First-line drugs only (d4T/3TC/NVP or ZDV/3TC/NVP)

20% of all patients change drug regimen because of toxicity

177.8

per treatment (on average)

(5)

 

Treatment of opportunistic infections

40% of all patients, requiring testing, 7-days hospitalization, and treatment

233

221

per treatment (on average)

(5)

Health centre costs

Outpatient visits

13, annually per patient

4.98

2.97

per outpatient visit, 95% coverage

(3)

No intensive monitoring, first- and second-line drugs

 

 

 

 

 

Drug costs

Combination of first- and second-line drugs (d4T/3TC/NVP or ZDV/3TC/NVP) and TTF/ddl/LPV/r)

70% of all patients are on first line drugs and 30% are resistant and change to second-line drugs

444.34

per treatment (on average)

(5)

 

Treatment for opportunistic infections

40% of all patients, requiring testing, 7-days hospitalization, and treatment

233

221

per treatment (on average)

(5)

Test costs

CD4+ test

4, annually per patient

37

per test

(6)

 

Viral load

4, annually per patient

52

per test

(6)

 

Blood chemistry

4, annually per patient

2

per test

(7)

 

Complete blood count

12, annually per patient

12

per test

(7)

Health centre costs

Outpatient visits

4, annually per patient

4.98

2.97

per outpatient visit, 95% coverage

(3)

Intensive monitoring, first- and second-line drugs

 

 

 

 

 

Drug costs

Combination of first- and second-line drugs ((d4T/3TC/NVP or ZDV/3TC/NVP) and TTF/ddl/LPV/r)

70% of all patients are on first line drugs and 30% are resistant and change to second-line drugs

444.34

per treatment (on average)

(5)

 

Treatment for opportunistic infections

40% of all patients, requiring testing, 7-days hospitalisation, and treatment

233

221

per treatment (on average)

(5)

Test costs

CD4+ test

4, annually per patient

37

per test

(6)

 

Viral load

4, annually per patient

52

per test

(6)

 

Blood chemistry

4, annually per patient

2

per test

(7)

 

Complete blood count

12, annually per patient

12

per test

(7)

Health centre costs

Outpatient visits

13, annually per patient

4.98

2.97

per outpatient visit, 95% coverage

(3)

* Table reports on patient-level costs and most important components of programme-level costs. All interventions also include other programme-level costs, such as salaries of central administrators and are reported in full detail at www.who.int/choice .

Resource use patterns were based on Soul City mass media campaign in South-Africa (http://www.soulcity.org.za/index.asp ).

In 25% of all tests, test result is positive and a confirmatory test is required.

§ Assuming 10% comply with follow-up visit.

|| In addition to these inputs, the interventions includes a voluntary counselling and testing component.

Drug costs vary by region because of local distribution costs. Prices were based on published prices from Mẽdicins sans Frontières (5). For costing purposes, we assumed that each of the monthly outpatient visits required for standard monitoring would be equivalent to one-third of a routine outpatient contact, while each of the weekly visits required for intensive monitoring would be equivalent to one-fourth of a routine outpatient contact.

**All unit costs are available at www.who.int/choice .

REFERENCES:

1. Johns B, Baltussen R, Adam T, Hutubessy RCW. Programme costs in the economic evaluation of health interventions. Cost Eff Resour Alloc. 2003; 1:1.

2. UNICEF / UNAIDS / WHO / MSF. Sources and prices of selected medicines and diagnostics for people living with HIV/AIDS. 2004.

3. Adam T, Evans DB, Murray CJL. Econometric estimation of country-specific hospital costs. Cost Eff Resour Alloc. 2003;1:3.

4. Essential Drug Price Indicator Guide at erc.msh.org/dmpguide (accessed 14 June 2005).

5. Médicins Sans Frontières. Untangling the web of price reductions: a pricing guide for the purchase of ARVs for developing countries (7th Edition). June 2005 (http://www.accessmed-msf.org/documents/untanglingtheweb%208.pdf ).

6. Djomand G, Roels T, Chorba T. HIV/AIDS Drug Access Initiative. Ministere de la Sante, Republic de Cote d’Ivoire. 2000.

7. World Bank. Confronting AIDS. Public priorities in a global epidemic. World Bank. 1997