The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #67589

Sergio Bautista, MS¹, Tania Dmytraczenko, PhD², Gilbert Kombe², Belkis Aracena¹, Lucero Cahuana¹, Rosalind Mowatt¹, Atanacio Valencia¹, and Stefano Bertozzi, MD, PhD³. (1) Center for Health Systems Research, Instituto Nacional de Salud Publica, Av. Universidad No. 655, Cuernavaca, Mexico, 011 52 777 311-3783, sbautista@correo.insp.mx, (2) International Health, Abt Associates Inc, Suite 600, 4800 Montgomery Lane, Bethesda, MD 20814, (3) Division of Health Economics and Policy, Instituto Nacional de Salud Publica, Avenida Universidad 655, Cuernavaca, Mexico

With declining prices for antiretroviral drugs (ARVs), there is growing demand to make ARV treatment available in developing countries. Policymakers and donors, under pressure to act quickly to provide drugs, need better information about the total costs of ARV treatment in a developing country context in order to structure effective, affordable, comprehensive treatment programs.

This study examines the national HIV/AIDS treatment program in three health sub-systems in Mexico and estimates total costs of providing ARV treatment (previous studies have focused on drug costs). Primary data on resources utilization was obtained from medical records of a convenience sample of 1062 patients with HIV/AIDS diagnostic and on costs from administrative sources in 11 health facilities in 3 Mexican states. Comprehensive data was captured on clinical events, use of outpatient, inpatient, laboratory services and medications. Lining patients up according to the year of initiation of highly active anti-retroviral therapy (HAART) shows a substantial increase in average annual per patient treatment cost pre-HAART (US$782-1184) and post-HAART (US$3258-4211). Drugs account for 72-78 percent of total treatment cost, which can be explained by the use of commercial rather than generic drugs and weaknesses in other treatment components, such as monitoring. Cost savings, when they occur, do not outweigh costs associated with initiation of HAART. This may be due, in part, to the fact that the vast majority of patients in the sample initiated HAART in advanced stages of disease progression (median CD4 count was 150 cells/ml in the year prior to initiation of HAART).

Learning Objectives:

• At the end of the session, participants will be able to:
• 1. Identify major cost components associated with the delivery of ARV treatment.
• 2. Articulate that countries deciding to implement ARV treatment programs should take a systems approach, taking into consideration elements other than drug provision in program design.

Keywords: HIV/AIDS, Cost Issues

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.