The impact of reduced drug prices on the cost-effectiveness of HAART in South Africa

South Africa has started ‘rolling out’ highly active anti-retroviral therapy (HAART) through the public health sector, but implementation has been slow. Studies have shown that in Africa AIDS prevention may be more cost-effective than providing HAART; such published results provide some support for the South African government’s apparent reluctance to implement a large-scale rapid HAART roll-out. However, previous studies have not linked treatment and prevention plans, and do not, for the most part, consider the potential savings to the public health sector (e.g., fewer hospital admissions) that may arise from the introduction of HAART. The South African costing exercise summarised here avoids both these limitations. It provides an update of earlier work and takes into account the recent decline in antiretroviral drug prices. It shows that once HIV-related hospital costs are included in the calculation, the cost per HIV infection averted is lower in a treatment-plus-prevention intervention scenario than it is in a prevention-only scenario. This suggests that it is economically advantageous to fund a large-scale comprehensive intervention plan and that the constraints for doing so are political. Once human-rights considerations are included, the case for providing HAART is even more compelling