[Ip-health] Aids breakthrough as study says treatment should cost less

Ira Glazer ira.glazer at gmail.com
Fri Jul 20 23:39:01 PDT 2012


Lack of money can no longer be considered a reason – or an excuse – for
failing to treat all those with HIV who need drugs to stay alive, following
game-changing work about to be published by the Clinton Foundation that
shows the real cost is four times less than previously thought.

The striking findings of a substantial study carried out in five countries
of sub-Saharan Africa <http://www.guardian.co.uk/world/africa> are hugely
important and will set a new hopeful tone for the International Aids
Conference in Washington, which opens on Sunday. It will help make the
argument for Barack Obama and other international donors to dig deeper into
their pockets – because the cost of saving lives, slowing the spread of HIV
and achieving the ambition of an Aids-free world is lower than anyone

The work by the Clinton Health Access Initiative (CHAI) shows that the
total cost of treatment in health facilities – including drugs, lab tests,
health workers' salaries and other overheads – comes to an average of $200
a patient a year across Ethiopia <http://www.guardian.co.uk/world/ethiopia>,
Malawi <http://www.guardian.co.uk/world/malawi>,
Zambia <http://www.guardian.co.uk/world/zambia> – four of the Aids-hit
African nations studied. That rises to $682 in South
which has higher salaries and lab costs.

Until now the generally accepted total cost of treating a patient for a
year was an average of $880 – based on a study by the US president's
emergency plan for Aids relief (Pepfar) released at the last International
Aids Conference two years ago in Vienna.

Bernhard Schwartländer, director of strategy at UNAids, believes the CHAI
work should lead to new optimism. "I think the cost argument is just a
false argument and it has been used as an escape. We do need more money but
it is not at a level that will be impossible," he said.

The costings are particularly important in the wake of recent scientific
findings that show putting people on antiretroviral drugs makes them far
less likely to infect others – helping to stop the spread of HIV as well as
keeping people alive. CHAI will also announce that it has negotiated down
the prices of some of the newer and most important drugs needed for
treatment by around a third.

Former US president Bill Clinton hailed the findings as evidence that all
15 million people with HIV in need of treatment could affordably get it –
the target for 2015. At the moment, 8 million are being treated. "We now
have compelling evidence that universal access to high-quality HIV
treatment is achievable, sustainable, and within our means," said Clinton.

"Together, the costing study and price reductions open the door to scaling
up and sustaining services for the 7 million people who currently lack
access to HIV treatment. Providing treatment will save lives and help
prevent the spread of HIV."

CHAI worked with the Centre for Global Development and the governments of
those African countries involved to collect data from 161 health facilities
for the last financial year on record – mostly 2010.

The original aim of the study was to find out whether there was any
potential to reduce waste, cut costs and save money, but researchers found
salaries and other costs were already so low that this was unlikely, except
possibly in South Africa.

Average costs per patient were lowest in Malawi, at $136 a year. That rose
to $186 in Ethiopia, $232 in Rwanda and $278 in Zambia. Nearly half the
cost, on average, was the price of drugs – which will increase slightly as
countries begin to use more effective and more expensive drugs now
recommended by the World Health Organisation. CHAI, however, is about to
announce a deal with generic drug companies, which will reduce
tenofovir-based regimens, which are the "gold-standard" in the USA and
recommended by the World Health Organisation, to $125 from $339 in 2007.
CHAI says this will save countries over $500 million between now and 2015.

Kate Condliffe, executive vice-president for HIV programmes at CHAI, said
finances were thought to be a bottleneck to expanding the numbers of drugs
in many countries. "The perception that treatment costs are higher is
casting a cloud over conversations on how to accelerate treatments," she

"You sit through conversations on treatment and prevention where there
should be incredible optimism, given the science, and yet there is concern
about feasibility and cost that lead to an incremental approach."

But while there are not huge opportunities to save money on treatment in
the clinics, there is a disparity between the costs at health facilities
and the costs at government level. That was illustrated this week in the
major UNAIDS report, which referred to national costs in Zambia – around a
third higher than costs in the clinic.

Schwartländer said that even if one assumed a cost of $300 a patient a
year, the bill to put 20 million people on HIV treatment would be $6bn a
year. "It is not outrageous. It can really be handled," he said. "Look at
the amount of money moving around in low-income countries. $6bn should not
shock us – it is not impossible. We need a different view from that of the
'treatment timebomb'."

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