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SEC T ION FI VE: PRE V EN T ION A ND M A N AGEMEN T IN RESOURCE- POOR SE T T INGS

CHAPTER 59
Pharmacoeconomics of HIV/AIDS Treatment
Mirn Ryan

Introduction
Treatment of HIV/AIDS imposes a signicant nancial burden, and therefore expenditure on drug therapy has been the subject of detailed analysis. Cost of care information is required to assess the economic impact of treatment, to compare the costeffectiveness of alternative treatment strategies, to determine the affordability of interventions and to facilitate healthcare resource planning. Differences in terms of prevalence and models of care are evident between high and lower income countries. Antiretroviral therapy constitutes a large part of cost of care in high income countries, whereas in low income countries, smaller proportions of HIVinfected patients receive antiretroviral therapy and inpatient care constitutes a greater proportion of expenditure. Comparison of cost of care between healthcare systems is compromised by differences in relative costs of constituents of care as well as differences in the methods used to calculate overall costs. Costs of treatment are lower in less-developed countries but the impact on the healthcare system may account for a greater proportion of healthcare resources and represent a far greater burden due to higher prevalence of disease.1

tive uses for the healthcare budget, thereby facilitating priority setting and hence resource allocation.2 Economic evaluation of pharmaceutical products (pharmacoeconomics) is increasingly used, reecting the recognition that healthcare decision makers are placing increased emphasis on value for money from healthcare interventions.

Methods of Economic Evaluation

All methods of pharmacoeconomic evaluation share the common feature of comparing inputs (cost) with outcomes (benets) resulting from drug intervention. The cost of drug therapy relates not only to the price of the drug but also includes direct and indirect costs. Direct costs include costs of staff and capital. Indirect costs might include loss of earnings, loss of productivity and cost of travel to hospital. Many of these costs are difcult to measure, as are intangible costs for pain or other distress a patient might suffer. As costs are expressed in monetary terms, the difference between economic evaluations resides in the measurement of benets. Such benets may be measured in natural units such as years of life saved following antiretroviral therapy. Benets may also be measured in terms of utility units such as quality of life. This combines assessment of physical activity such as degree of mobility and psychosocial outcomes such as anxiety and ability to cope. The Quality Adjusted Life Year (QALY) is a measure of health outcome, which includes quality and quantity of life. An alternative measure of health outcome frequently used in economic evaluations in developing world settings is the Disability Adjusted Life Year (DALY), which also attempts to reect quality

Pharmacoeconomics
The fundamental economic problem is scarcity. Economic scarcity means that choices have to be made in allocating healthcare resources. The basic task of an economic evaluation is to identify, measure, value, and compare the costs and consequences of alterna-

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