HIV is the leading cause of premature death in Thailand. Since the first case of AIDS was reported in 1984, more than one million Thais have become infected. The social, human, and economic costs of this burden are enormous.

This book presents the results of a joint study between the World Bank and the Ministry of Health of the Royal Thai Government (RTG) to assess the likely benefits, costs, and consequences of the government’s 2003 initiative to expand public provision of antiretroviral therapy (ART).

Using an innovative combination of economic and epidemiologic modeling, the authors evaluate the impact of alternative policies on relevant health and policy indicators. They estimate that ART will save years of healthy life at a cost of between $700 and $2,400 per life-year, depending on program choices.

Successful AIDS treatment accumulates ever-increasing numbers of patients who need subsidized ART. Despite the magnitude of the resulting fiscal burden, the authors judge this expenditure to be a worthwhile public health investment. However, they show that the sustainability of the program will hinge critically on the effectiveness of the government’s policies in three key areas: the reinforcement of past successes in HIV prevention, the quality of ART service delivery, and the success of negotiations with multinational pharmaceutical manufacturers on the prices of new AIDS drugs.

Front cover note: Twelve-year-old girls in Pang Lao school in Thailand’s Chiang Rai Province learn about social groups most at risk from HIV infection.

Download The Economics of Effective AIDS Treatment: Evaluating Policy Options for Thailand

PDF FORMAT, 6MB, 270PAGES.

The Economics of Effective AIDS Treatment: Evaluating Policy Options for Thailand
Ana Revenga, Mead Over, Emiko Masaki, Wiwat Peerapatanapokin, Julian Gold, Viroj Tangcharoensathien, Sombat Thanprasertsuk
With a Foreword by Sombat Thanprasertsuk, M.D., Ministry of Public Health, Thailand
With contributions from Tim Brown, Chris Duncombe, Jongkol Lertiendumrong, Seri Phongphit, Bussaba Tantisak, and David Wilson

© 2006 The International Bank for Reconstruction and Development / The World Bank

Foreword:

We in the National AIDS Prevention and Problem Alleviation Program of the Kingdom of Thailand bear the responsibility for managing national and non-national resources that are spent on protecting people from being infected with HIV and to provide care and treatment for the people who have already been infected. In this capacity, we are constantly aware of the need to balance the resources used for one aspect against those for another. Like officials in public health programs in other countries, we often have difficulty justifying expenditures to prevent disease when there are such clear and urgent needs all around us for treatment of people who are already sick. This is because well people are seldom aware that they have been saved from illness or death by a prevention expenditure made years previously by the Program. On the other hand, people who have been treated and are recovering attribute their recovery to those who helped them. It is more obvious and popular for a government to provide treatment than to provide prevention. Although the subject matter of this book is the economics of AIDS treatment, perhaps its most important lessons are in the area of prevention.

After carefully computing the probable future cost of Thailand’s ARV treatment program, the authors have been able to compare that cost to the much larger cost that Thailand would have had to shoulder if the country had not engaged in such a vigorous HIV prevention program in the 1990s. They estimate that for every Baht that the Thai government spent on HIV prevention in the 1990s, 43 Baht of government expenditure on treatment has been avoided. Even if they have underestimated by 50 percent the cost of prevention (for example, by leaving out the value of the many voluntary contributions to HIV prevention of the members of many national NGOs) and overestimated the savings by a factor of two (because some of the reduction in risk behavior might have occurred without government intervention), one would estimate a saving of 10 Baht for every Baht spent on prevention. These calculations demonstrate the value of prevention of HIV and suggest that prevention of other diseases that afflict the nation might also be worthwhile investments.

This study forecasts that government spending on ARV therapy through the National Access to ARV for People with HIV and AIDS (NAPHA) will rise to equal 24 percent of the projected government health budget in the year 2013. But costs will rise even more if the availability of treatment leads to a return of high-risk behavior. The threat of these future costs has led to decisions by the National AIDS Committee early in 2006 to refocus on HIV prevention. In a speech at the United Nations General Assembly in New York in June 2006, Thailand announced that its new goal is to reduce by half the previously expected annual number of new HIV infections by the year 2010. To meet this goal, all stakeholders, including the government agencies and its civil society partners, will work together to sustain condom use where it is high and to increase it where it is low. New free condom distribution programs will be targeted to those particularly likely to contract and transmit HIV, including the discordant couples, female sex workers and their clients, intravenous drug users, men who have sex with men, clients of VCT and STI clinics, and youth as a cross-sectional group.

In view of the large cost of second-line drugs at current prices, the ARV Program is working with partners such as the Global Fund and Médecins sans Frontières to maximize the benefits of first-line therapy for each patient. As recommended in this study, we are expanding the coverage of patient support groups attached to each public antiretroviral treatment center.

We in the National AIDS Prevention and Problem Alleviation Program appreciate that the estimates in this book, although based on the best current information about costs and effects, are subject to change over time. The analytical framework used will be useful as we periodically return to these issues and construct new forecasts based on the most recent information. We look forward to future collaboration with the World Bank in the analysis of selected health sector policy issues.

Sombat Thanprasertsuk, M.D., M.P.H.
Director, Bureau of AIDS, Tuberculosis, and Sexually Transmitted Infections

Visit The Econimics of Effective AIDS Treatment WORLD BANK's Web Site

Executive Summary

Background

Thailand is in the vanguard of developing countries that are seeking to provide antiretroviral therapy (ART) as the standard of care to large numbers of people with symptomatic HIV disease. As of May 2006, 77,758 people living with HIV/AIDS in Thailand had received ART through the National Access to Antiretroviral Program for People Living with HIV/AIDS (or NAPHA), and approximately 8,000 are estimated to have access to ART through the Social Security Scheme. The Thai government’s objective is to provide ART to 82,000 people living with HIV/AIDS by end of fiscal year 2006.

The purpose of this report is to advise the Thai government and Thai society at large about the full range of benefits, costs, and consequences that are likely to result from the decision to expand public provision of ART through NAPHA and to assist with the design of implementation policies that will achieve maximum treatment benefits, while promoting prevention of HIV/AIDS and maintaining financial sustainability within Thailand.

Provision of ART in Thailand

The first case of AIDS in Thailand was reported in September 1984. Since then, more than 1 million Thais have been infected with HIV, and, of those, more than 400,000 have died. In 2004, an estimated 572,500 Thais were living with HIV/AIDS (table ES.1). Among those people, some 49,500 will develop serious AIDS-related illnesses during the year, and about the same number will die of AIDS-related complications. It is also estimated that 19,500 new infections will occur in 2004 (compared with 143,000 new infections in 1990 and 23,676 new infections in 2002). ...

Comments (0)

Show/Hide comments

Name

Email

Website

Title

Comment

smaller | bigger

Add Comment