Boulle Andrew, Kenyon Christopher, Skordis Jolene, Wood Robin
School of Public Health and Primary Health Care, University of Cape Town.
S Afr Med J. 2002 Oct;92(10):811-7.
The role of antiretroviral treatment for adults in the pubic sector in South Africa is debated with little consideration of programme choices that could impact on the cost-effectiveness of the intervention. This study seeks to explore the impact of these programme choices at an individual level, as well as explore the total cost of a rationed national public sector antiretroviral treatment programme.
Eight scenarios were modelled of limited national treatment programmes over the next 5 years, reflecting different programme design choices. The individual cost-effectiveness of these scenarios were compared. The total costs of the most cost-effective scenario were calculated, and the potential for savings in other areas of health care utilisation was explored.
The direct programme costs per life-year saved varied between scenarios from R5,923 to R11,829. All the costs of the most cost-effective scenario could potentially be offset depending on assumptions of health care access and utilisation. The total programme costs for the most cost-effective scenario in 2007 with 107,000 people on treatment are around R409 million.
Specific policy choices could almost double the number of people who could benefit from an investment in a limited national antiretroviral treatment programme. Such a programme is affordable within current resource constraints. The consideration of antiretroviral treatment calls for a unique public health approach to the rationing of health services in the public sector.
在南非公共部门，成人抗逆转录病毒治疗的作用存在争议，而对可能影响干预措施成本效益的方案选择却很少考虑。本研究旨在探讨这些方案选择在个体层面的影响，并探究国家公共部门抗逆转录病毒治疗配给方案的总成本。
针对未来5年有限的国家治疗方案构建了8种情景模型，反映不同的方案设计选择。对这些情景的个体成本效益进行了比较。计算了最具成本效益情景的总成本，并探究了在其他医疗保健利用领域节省成本的可能性。
每个挽救生命年的直接方案成本在不同情景中介于5923兰特至11829兰特之间。根据医疗保健可及性和利用情况的假设，最具成本效益情景的所有成本有可能得到抵消。2007年最具成本效益情景下，有10.7万人接受治疗，方案总成本约为4.09亿兰特。
特定的政策选择可能使从有限的国家抗逆转录病毒治疗方案投资中受益的人数几乎增加一倍。这样一个方案在当前资源限制范围内是可承受的。对抗逆转录病毒治疗的考量需要一种独特的公共卫生方法来对公共部门的卫生服务进行配给。
