Public Health Foundation of India, New Delhi, India.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America.
PLoS One. 2018 Nov 12;13(11):e0206988. doi: 10.1371/journal.pone.0206988. eCollection 2018.
India has scaled-up antiretroviral treatment (ART) in public sector facilities, but data to understand time trends of average cost of ART are limited.
Cost and output data were collected at all public sector ART centres in undivided Andhra Pradesh (high-HIV burden state) and Rajasthan (low-HIV burden state) in India from fiscal year 2007-2008 to 2012-2013. Average cost per patient for first-line ART, and its relation with scale of services, were assessed. Using data on scale of services, the average cost was estimated up to 2015-2016. Break-even point was estimated from average and marginal cost functions. Costs were adjusted to 2015 constant price.
The average cost per patient alive and on ART in 2015-2016 was US$162 in undivided Andhra Pradesh and US$186 in Rajasthan, which was 51.4% and 35.8% lower than in 2007-2008, respectively. Average ART drug cost declined by 27.2% during this period, and was 70.9% and 61.5% of the total ART cost in the two states in 2015-2016. The average cost other than ART drugs declined by 73.1% and 45.7%, with the number of patients served increasing 7 and 14.2 times, respectively. Average cost other than ART drugs had a significant negative relation with scale (R2 = 86.4%-82.8%, p<0.001). Break-even analysis suggested that 47.5% and 58.8% of the ART centres in undivided Andhra Pradesh and Rajasthan, respectively, were functioning below optimal scale in 2015-2016. The estimated total economic cost of first-line ART services provided in the public sector in India in fiscal year 2015-2016 was US$ 151 million; it would be US$ 216.1 million to provide this to all eligible persons in India.
The average cost of providing first-line ART has declined in India, and further reduction is possible if the optimal scale of services is achieved. These findings can inform resource requirement for the ART programme in India.
印度在公共部门扩大了抗逆转录病毒治疗（ART）的规模，但用于了解 ART 平均成本时间趋势的数据有限。
从 2007-2008 财年到 2012-2013 财年，在印度安得拉邦（艾滋病毒负担高州）和拉贾斯坦邦（艾滋病毒负担低州）的所有公共部门 ART 中心收集成本和产出数据。评估了一线 ART 每位患者的平均成本与其服务规模的关系。利用服务规模数据，估计了 2015-2016 年的平均成本。从平均成本和边际成本函数中估算出收支平衡点。对成本进行了 2015 年不变价格调整。
2015-2016 年，未分割安得拉邦每位存活和接受 ART 治疗的患者的平均成本为 162 美元，拉贾斯坦邦为 186 美元，分别比 2007-2008 年降低了 51.4%和 35.8%。在此期间，ART 药物的平均成本下降了 27.2%，在这两个州 2015-2016 年的总成本中占 70.9%和 61.5%。ART 药物以外的平均成本下降了 73.1%和 45.7%，服务患者人数分别增加了 7 倍和 14.2 倍。ART 药物以外的平均成本与规模呈显著负相关（R2=86.4%-82.8%，p<0.001）。收支平衡分析表明，2015-2016 年，未分割安得拉邦和拉贾斯坦邦分别有 47.5%和 58.8%的 ART 中心的运营规模低于最佳水平。2015-2016 年，印度公共部门提供的一线 ART 服务的总经济成本估计为 1.51 亿美元；如果将其提供给印度所有符合条件的人，总成本将为 2.161 亿美元。
印度提供一线 ART 的平均成本有所下降，如果达到最佳服务规模，成本还有进一步下降的可能。这些发现可以为印度的 ART 规划提供资源需求信息。
