Over Mead, Revenga Ana, Masaki Emiko, Peerapatanapokin Wiwat, Gold Julian, Tangcharoensathien Viroj, Thanprasertsuk Sombat
Center for Global Development, 1776 Massachusetts Avenue NW, Washington, DC 20036, USA.
AIDS. 2007 Jul;21 Suppl 4:S105-16. doi: 10.1097/01.aids.0000279713.39675.1c.
The speed with which Thailand has scaled up public provision of antiretroviral therapy (ART) has been unprecedented, with more than 80 000 individuals on treatment at the end of 2006 through Thailand's National Access to Antiretroviral Program for People Living with HIV/AIDS (NAPHA). This paper projects the cost effectiveness, the affordability and the future fiscal burden of NAPHA to the government of Thailand under several different policy scenarios until the year 2025.
An economic/epidemiological model of access to ART was constructed, and this composite model was calibrated to economic and epidemiological data from Thailand and other countries. The economic model adopts the conditional logit specification of demand allocation across multiple treatment modes, and the epidemiological model is a deterministic difference-equation model fitted to the cumulated data on HIV incidence in each risk group.
The paper estimates that under 2005 prices NAPHA will save life-years at approximately US$736 per life-year saved with first-line drugs alone and for approximately US$2145 per life-year if second-line drugs are included. Enhancing NAPHA with policies to recruit patients soon after they are first eligible for ART or to enhance their adherence would raise the cost per life-year saved, but the cost would be small per additional life-year saved, and is therefore justifiable. The fiscal burden of a policy including second as well as first-line drugs would be substantial, rising to 23% of the total health budget by 2014, but the authors judge this cost to be affordable given Thailand's strong overall economic performance. The paper estimates that a 90% reduction in the future cost of second-line therapy by the exercise of Thailand's World Trade Organization authority to issue compulsory licences would save the government approximately US$3.2 billion to 2025 and reduce the cost of NAPHA per life-year saved from US$2145 to approximately US$940.
泰国扩大抗逆转录病毒疗法（ART）公共供应的速度史无前例，截至2006年底，通过泰国国家艾滋病毒/艾滋病感染者抗逆转录病毒治疗项目（NAPHA），已有超过8万人接受治疗。本文预测了在几种不同政策情景下，直至2025年NAPHA对泰国政府的成本效益、可承受性及未来财政负担。
构建了一个ART获取的经济/流行病学模型，并根据泰国和其他国家的经济及流行病学数据对这个综合模型进行校准。经济模型采用了多种治疗模式间需求分配的条件logit规范，流行病学模型是一个确定性差分方程模型，适用于每个风险组中艾滋病毒发病率的累积数据。
本文估计，按2005年价格计算，仅使用一线药物时，NAPHA每挽救一个生命年的成本约为736美元，若纳入二线药物，则每挽救一个生命年的成本约为2145美元。通过在患者首次符合ART治疗条件后尽快招募患者或提高其依从性的政策来加强NAPHA，会提高每挽救一个生命年的成本，但每多挽救一个生命年的成本很小，因此是合理的。包括一线和二线药物的政策的财政负担将是巨大的，到2014年将升至卫生总预算的23%，但鉴于泰国强劲的整体经济表现，作者认为这一成本是可承受的。本文估计，通过行使泰国在世界贸易组织的权力颁发强制许可，将二线治疗的未来成本降低90%，到2025年将为政府节省约32亿美元，并将NAPHA每挽救一个生命年的成本从2145美元降至约940美元。
