‘Time is costly’: modelling the macroeconomic impact of scaling-up antiretroviral treatment in sub-Saharan Africa

Ventelou, Bruno; Moatti, Jean‐Paul; Videau, Yann; Kazatchkine, Michel D.

doi:10.1097/qad.0b013e3282f1d49f

Cited by 29 publications

(9 citation statements)

References 30 publications

(30 reference statements)

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“…These studies suggest that, in the absence of effective treatment, substantial productivity losses – on the order of a one percent reduction in gross domestic product (GDP) growth per year – could occur in countries with generalized HIV epidemics [6], [49], [62], [63], [64], [65], [66].…”

Section: Discussionmentioning

confidence: 99%

Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries

Resch¹,

Korenromp

Stover

et al. 2011

PLoS ONE

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Since the early 2000s, aid organizations and developing country governments have invested heavily in AIDS treatment. By 2010, more than five million people began receiving antiretroviral therapy (ART) – yet each year, 2.7 million people are becoming newly infected and another two million are dying without ever having received treatment. As the need for treatment grows without commensurate increase in the amount of available resources, it is critical to assess the health and economic gains being realized from increasingly large investments in ART. This study estimates total program costs and compares them with selected economic benefits of ART, for the current cohort of patients whose treatment is cofinanced by the Global Fund to Fight AIDS, Tuberculosis and Malaria. At end 2011, 3.5 million patients in low and middle income countries will be receiving ART through treatment programs cofinanced by the Global Fund. Using 2009 ART prices and program costs, we estimate that the discounted resource needs required for maintaining this cohort are $14.2 billion for the period 2011–2020. This investment is expected to save 18.5 million life-years and return $12 to $34 billion through increased labor productivity, averted orphan care, and deferred medical treatment for opportunistic infections and end-of-life care. Under alternative assumptions regarding the labor productivity effects of HIV infection, AIDS disease, and ART, the monetary benefits range from 81 percent to 287 percent of program costs over the same period. These results suggest that, in addition to the large health gains generated, the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment.

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Section: Discussionmentioning

confidence: 99%

Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries

Resch¹,

Korenromp

Stover

et al. 2011

PLoS ONE

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“…The economic Impact of HIV/AIDS will take generations to unfold and will be modified at each level (households, firms and sectors, macroeconomy as a whole) by scaling up of access to prevention and treatment (Veenstra & Whiteside, 2005;Ventelou, Moatti, Videau, & Kazatchkine, 2008). For example, the paper by Hubben et al about Northern Italy calls attention to the fact that the societal burden of HIV/AIDS encompasses many more economic losses than the medical costs directly incurred by the health systems.…”

Section: Pursuing the Long-term Research Agendamentioning

confidence: 99%

Editorial: HIV/AIDS: a long-term research agenda for social sciences

Moatti

Spire

2008

AIDS Care

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“…On the other hand, there have been macroeconomic estimations of the impact of HIV/AIDS integrating epidemiological dynamics into neoclassical or “endogenous growth” models [15]–[18]. However, proper estimates of the economic impact of alternative funding scenarios for HIV treatment have to be based on the potential consequences of each scenario for the future life-history of affected individuals and, jointly, on an aggregation of these effects for the whole dynamics of the economy.…”

Section: Introductionmentioning

confidence: 99%

The Macroeconomic Consequences of Renouncing to Universal Access to Antiretroviral Treatment for HIV in Africa: A Micro-Simulation Model

et al. 2012

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AimPrevious economic literature on the cost-effectiveness of antiretroviral treatment (ART) programs has been mainly focused on the microeconomic consequences of alternative use of resources devoted to the fight against the HIV pandemic. We rather aim at forecasting the consequences of alternative scenarios for the macroeconomic performance of countries.MethodsWe used a micro-simulation model based on individuals aged 15–49 selected from nationally representative surveys (DHS for Cameroon, Tanzania and Swaziland) to compare alternative scenarios : 1-freezing of ART programs to current levels of access, 2- universal access (scaling up to 100% coverage by 2015, with two variants defining ART eligibility according to previous or current WHO guidelines). We introduced an “artificial” ageing process by programming methods. Individuals could evolve through different health states: HIV negative, HIV positive (with different stages of the syndrome). Scenarios of ART procurement determine this dynamics. The macroeconomic impact is obtained using sample weights that take into account the resulting age-structure of the population in each scenario and modeling of the consequences on total growth of the economy.ResultsIncreased levels of ART coverage result in decreasing HIV incidence and related mortality. Universal access to ART has a positive impact on workers' productivity; the evaluations performed for Swaziland and Cameroon show that universal access would imply net cost-savings at the scale of the society, when the full macroeconomic consequences are introduced in the calculations. In Tanzania, ART access programs imply a net cost for the economy, but 70% of costs are covered by GDP gains at the 2034 horizon, even in the extended coverage option promoted by WHO guidelines initiating ART at levels of 350 cc/mm3 CD4 cell counts.ConclusionUniversal Access ART scaling-up strategies, which are more costly in the short term, remain the best economic choice in the long term. Renouncing or significantly delaying the achievement of this goal, due to “legitimate” short term budgetary constraints would be a misguided choice.

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‘Time is costly’: modelling the macroeconomic impact of scaling-up antiretroviral treatment in sub-Saharan Africa

Cited by 29 publications

References 30 publications

Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries

Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries

Editorial: HIV/AIDS: a long-term research agenda for social sciences

The Macroeconomic Consequences of Renouncing to Universal Access to Antiretroviral Treatment for HIV in Africa: A Micro-Simulation Model

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