Evidence map›Paper›PMID 30419042›Full record

ArticlePloS one2018

Decreasing cost of public sector first-line ART services in India from 2007-2008 to 2015-2016.

G Anil Kumar, Rakhi Dandona, Bharat B Rewari, S G Prem Kumar, Sukarma Tanwar, Marielle C Gagnier, Venkata S Vishnumolakala, Lalit Dandona

Abstract read
In one paragraph

Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

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3 · Its place in the literature

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1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

G Anil KumarPublic Health Foundation of India, New Delhi, India.ORCID 0000-0002-7986-0905
Rakhi DandonaPublic Health Foundation of India, New Delhi, India.
Bharat B RewariNational AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India, New Delhi, India.
S G Prem KumarPublic Health Foundation of India, New Delhi, India.ORCID 0000-0001-5632-4862
Sukarma TanwarPublic Health Foundation of India, New Delhi, India.
Marielle C GagnierInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America.
Venkata S VishnumolakalaPublic Health Foundation of India, New Delhi, India.
Lalit DandonaPublic Health Foundation of India, New Delhi, India.ORCID 0000-0002-3114-8628

Funding

World Health Organization 001
6 · The paper itself

Abstract

introductionIndia has scaled-up antiretroviral treatment (ART) in public sector facilities, but data to understand time trends of average cost of ART are limited. MATERIALS AND

methodsCost 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.

resultsThe 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.

conclusionThe 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.

Indexed as

Health Care CostsAnti-Retroviral AgentsHIV InfectionsHumansIndiaPublic SectorAnti-Retroviral Agents

Identifiers

PMID30419042
PMCPMC6231637

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