therapy aims to suppress the virus to the point where it is undetectable in a patient’s blood. Since we do not attempt to synthesize the evidence further, for example by creating a mean cost and cost range of a single intervention from several such reported estimates, we do not think that our analysis is subject to reporting bias. It is estimated that the first‐line regimen of antiretroviral treatment for adults and children costs about US$368 per person per year (about 1US$ per day). Super-organized, savvy patient groups all over the world banded together to make H.I.V. There are lots of antiretroviral drugs, and they can be combined in different ways. This paper reviews available information on the costs for two types of services: a) Interventions: These were all biomedical or behavioural interventions for which available evidence showed a direct impact on HIV risk, transmission, morbidity and mortality; b) Technical efficiency (TE) factors: These were defined as activities that improve the technical efficiency of existing programmes, often by increasing their quality, uptake or coverage, but only affect a single intervention- in contrast to the enablers and synergies that have the potential to affect a number of interventions, possibly across different programme areas. A large number of modelled economic analyses of HIV interventions in South Africa use as inputs the same, often outdated, cost analyses, without reference to additional literature review. The same is true for Mylan’s three-drug combos. So patients could end up paying more out of pocket for a $1,000 generic than for a $30,000 brand-name drug. Of these 1,054 papers, 219 (21%) were duplicates, and 18 (2%) could not be found, leaving us with 817 papers for full-text screening (see Fig 1 for PRISMA diagram). In our review we were able to find literature detailing the results of primary cost analyses for five out of the 11 intervention categories included in the Investment Case, including for most of the HCT technical efficiency factors. The usual price drop with the first generic is small — 15 percent or less. The specific roles of this author is articulated in the ‘author contributions’ section. For more information, we suggest to contact either the authors of the papers we reference or, if more information on the ingredients cost summarised in S4 Table is required, the corresponding author of this paper. It’s good for patients — and rather unusual in the American health care system — that they needn’t worry about paying for expensive drugs. This isn’t an accident. Funding: The study was funded by the United States Agency for International Development (grant AID 674-A-12-00029) (G.M.-R.’s, C. v. R.’s, C. C.’s, R. L.’s and L. J.’s time) and UNAIDS (grant awarded to Gesine Meyer-Rath). The median incremental saving per patient per year among cost -saving models was $67. Because the analysis optimised interventions and intervention coverage based on cost effectiveness, the cost of services was a central input into the analysis; at the same time, the analytical framework mandated that even though interventions could be excluded if there was no evidence as to their effectiveness, they could not be excluded if data on their cost was missing, leaving us with the task of establishing the cost of each of the interventions included in the Investment Case. Our big problem in America is that too many people with H.I.V. Similarly, drug costs, also a significant contributor to total costs, do not increase each year with inflation as the costs are negotiated through a tender process and may be fixed for a number of years, and in the past the prices tended to decrease as a result of tender negotiations. The agreement‚ negotiated with international organisations and agencies‚ meant the fixed-dose combination treatment will cost about $75 (about R991) per person a year. There are several different types and they work in different ways. For most of these estimates we updated input costs to more recent prices, using the same input costs as for those interventions costed based on ingredients. Drug name (brand name) Cost of brand name: Cost of generic: Number of tablets or capsules: Strength: etravirine (Intelence) $1,296–$1,523: … Other specified cost items not attributable to these categories comprised nutritional support or supplements [35,36], communication costs [37], the costs of end of life care [34], field materials [38] and start-up costs [39], bank and interest charges [40] and insurance costs [41]. drugs. Of the estimated 36.7 million individuals living with HIV worldwide in 2015, approximately 70% resided in sub-Saharan Africa (SSA) . drugs. He was the chief of staff to the first leader of the Global Fund and later chief executive of the Clinton Health Access Initiative. All cost data taken from published estimates was updated to 2016 South African Rand (ZAR) using the South African consumer-price index published by StatsSA [28] and relevant exchange rates if the estimate was not given in ZAR. No, Is the Subject Area "South Africa" applicable to this article? No, Is the Subject Area "HIV epidemiology" applicable to this article? Of these, 775 (95%) papers were excluded after full-text review, 530 (68% of those excluded) because no cost data was provided, 113 (15%) because no primary cost data was reported, ie, the cost data used in the paper came from another study, 67 (9%) because the intervention was not relevant to our search, 56 (7%) because the setting was not South Africa, and 6 (1%) because the paper described a study protocol only, not the results. https://doi.org/10.1371/journal.pone.0210497.g001, https://doi.org/10.1371/journal.pone.0210497.t001. Thirty-two papers (76%) presented full cost, 8 papers (19%) incremental costs, one paper (2%) reported both [32], and one paper (2%) did not give any information [33]. That’s true even for Medicare and Medicaid, where tax dollars pay the bills. (Prices quoted are from the government’s survey of what pharmacies pay. Just under half of all people living with H.I.V. “Whenever I hear that, I pretty much have a seizure,” said Dr. Daskalakis. Oh, and the price — together the two generics add up to $1,635 per year. broad scope, and wide readership – a perfect fit for your research every time. It’s also good for everyone else: If people couldn’t afford their meds, we’d have many more deaths, huge hospital bills and an uncontrollable H.I.V. AIDS triple-combination therapy, which costs US$ 10 000 per patient per year in industrialized countries, can now be obtained from Indian generic drugs company, Cipla, for less than US$ 200 per year. Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, In this method, the relationship between inputs and outputs (in this case, services rendered) is even harder to establish, as invoices might have not been paid on time and the charges paid could have been higher than the actual cost of inputs. But that may be starting to change. Our review has a number of other limitations. 35% of services were costed based on ingredients; the remaining 10% of services were costed based on expenditure data. The analysis used a unit cost model that calculates the cost of each ingredient used in producing 1 output of an intervention and then aggregates the ingredient costs to arrive at a total unit cost per output of the intervention. Yes Validation, If patients have high out-of-pocket costs, such as co-pays and co-insurances, makers of brand-name H.I.V. Follow The New York Times Opinion section on Facebook and Twitter (@NYTopinion), and sign up for the Opinion Today newsletter. Plenty of drugs carry outrageous prices: EpiPens, insulin, cancer treatments, even some antibiotics. For those without private insurance, Medicare or Medicaid, the Ryan White AIDS Drug Assistance Program steps in. Only in the absence of any such information did we use ingredient costing to establish the unit cost of a service, based on published data on the type and number of resources used in the intervention (such as staff, consumables, equipment, drugs and laboratory tests), and input costs (prices, salaries, etc) from a variety of sources. In economic analyses of HIV interventions, South Africa is often used as a case in point, due to both the size of its HIV-positive population and the number of people in need of and receiving services as well as the availability of good data on the course of its HIV epidemic and the outcomes of interventions. 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