National Health Insurance
Estimates of the Cost of Treatment in the Public Sector
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The ASSA models have played a major role determining the cost of treatment of HIV/AIDS in the public sector. The first version of the intervention model was used as the basis for a highly-influential piece of research by Nathan Geffen, Prof Nicoli Natrass and Chris Raubenheimer. The authors combined “detailed information about the costs of implementing these interventions with demographic projections of their impact. Information about prices, wages and other cost components” was gathered and included.
The research produced significant results “HAART is expensive, but the net costs to government are significantly lower than the direct costs of providing HAART. This is because people on HAART experience fewer opportunistic infections (OIs) – thereby saving the government the costs of treating those OIs. We estimate these ‘hospital costs averted’, provide a brief discussion of the savings associated with fewer orphans, and then conclude with a calculation of the cost of prevention and treatment programmes as a percentage of GNP.”
This work played a major role in the assessment by the Department of Health and the National Treasury of the cost-effectiveness of treatment and the eventual decision by Cabinet in 2003 to roll-out ARVs in the public sector.
It would be valuable for the development of a National Health Insurance system for the costs of HIV to be estimated again, using more recent prices. To this end, spreadsheets have been extracted from the latest version of the ASSA2003 model by staging of the epidemic and have been made available on the IMSA web-site. These can be used to model the epidemic for the whole country.
The user guide to the ASSA2003 model explains the expected diseases at various points in the staging: “The first two stages are largely asymptomatic. Symptoms occur more frequently in stage 3, and include weight loss and oral infections. People in stage 4 experience a range of more severe conditions, such as pneumonia, extrapulmonary TB and wasting syndrome. These conditions are referred to collectively as AIDS.” “In the absence of treatment, individuals are assumed to progress through each of the four WHO stages sequentially, before dying from AIDS. Individuals who initiate ART are assumed to do so at the time that they experience their first AIDS-defining illness, and move into stage 5 on initiating ART. People may die from AIDS while receiving ART or may discontinue treatment before dying from AIDS.”
From notes from Aid for AIDS: HAART is Highly Active Antiretroviral Therapy and usually consists of a combination of three ART drugs (2 NRTI + NNRTI or PI). It lowers the viral load, often to below the detection level. HAART may be sustained for years if taken correctly and is associated with weight gain and general well being. There is less risk of “opportunistic” illnesses while on HAART and it dramatically slows the progression to AIDS.
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