Table III.

Delivery Unit Cost of Antiretroviral Treatment, per patient-year, upper-middle-income countries

Country	Reference	City/Setting	Scope		Provider type	ART unit costs, in 2009 USD	Costs components, in 2009 USD (% of total cost)				ART Regimen
			Facilities	Patients			ARV drugs	Personnel	Laboratory tests	Overheads
Brazil	Acurcio A, et al. 2006m * [35]	Belo Horizonte/U	2	157 adherents patients	Nat	1,454	1,290.3 (88.7%)	6.2 (0.4%) Infectious diseases specialist and other specialists	45 (3%) Lymphocyte CD4/CD8, viral load test, other tests	Not included	NA
				40 non-adherents patients		1,340.1	1,290.3 (96.3%)	8.7 (0.6%) Infectious diseases specialist and other specialists	39.9 (2.9%) Lymphocyte CD4/CD8, viral load test, other tests
	Marques H, et al. 2007 w[23]	Sao Paulo/U	1	140 Outpatient children	Nat	2,038.8	Included but not unbundled	Included but not unbundled	Included but not unbundled	Included but not unbundled	RTV+NFV+3CT+ZDV+ddI+IDV
Mexico	Aracena-Genao B, et al. 2008n[36]	Mexico City/U	1	80	Nat	7,688	Included but not unbundled	Included but not unbundled	Included but not unbundled	Included but not unbundled	NA
	Bautista-Arredondo S, et al. 2003; Bautista-Arredondo S, et al. 2008o[37, 38]	Mexico City/U; Cuernavaca/U; Guadalajara/U	11	902	Nat	6,651.3 First year after ART treatment	6,024.4 (90.6%)	Included but not unbundled	223.4 (3.4%)	Included but not unbundled	NA
						4,256.8 Second year after ART treatment	3, 809.4 (89.5%)		165.8 (3.9%)
						4,682.9 Third year after ART treatment	3,960.7 (84.6%)		254.6 (5.4%)
South Africa	Cleary S, et al. 2006p[39]	Cape Town/U	3	1,729	Nat	987.3	338.8 (34.3%)	Included but not unbundled	96 (9.7%)	Included but not unbundled	AZT + 3TC+NVP/EFV First-line Treatment
						1,774.3	1,108.3 (62.5%)		112 (6.3%)		AZT + ddl + LPV/RTV Second-line treatment
	Deghaye N, et al. 2006q [40]	Durban/U	2	41	Nat	1,022.3	411 (40.2%)	330 (32.3%)	218.8 (21.4%)	16.4 (1.6%)	d4T + 3TC+ EFV First-line treatment
	Harling G, Bekker J, et al 2007r[41]	Cape Town/U	1	NT	Nat/D	521.6	Included but not unbundled	Included but not unbundled Doctor, nurse, counselor, pharmacist	Included but not unbundled	Included but not unbundled	NT
	Harling G, Wood R. 2007s[42]	Cape Town/U	1	172 outpatients	Nat/NGO	1,296.5	535.9 (41.3%)	203.3 (15.7%)	341 (26.3%)	25.2 (1.9%)	d4T + 3TC + EFV First-line treatment
				129 inpatients		1,834.3	535.9 (29.2%)	545.5 (29.7%)	442.1 (24.1%)	212.7 (11.6%)
	Kevany S, et al. 2009t[43]	Cape Town/U	1	48 outpatients	Nat	1,795.8	103.9 (5.8%)	988.6 (55.1%) Consultant, medical officer, nursing sister, medical ward staff	478.1 (26.6%)	Not included	3TC + d4T + NVP First-line Treatment
				25 inpatients		6,579.5	271.7 (4.1%)	2,097.8 (31.9%) Consultant, medical officer, nursing sister, medical ward staff	847.6 (12.9%)
	Martinson N, et al. 2009u [44]	Soweto/U	1	591	D	2,853.6 Newly ART patients	958 (33.6%)	435.5 (15.3%) Primary health care nurse, pharmacist, medical officer	1,174.4 (41.2%)	190.5 (6.7%)	d4T + 3TC + NVP First-line treatment
						1,770.4 Established-ART patients	958 (54.1%)	435.5 (24.6%) Primary health care nurse, pharmacist, medical officer	114.5 (6.5%)	190.5 (10.8%)
	Rosen S, et al. 2008v [45]	Gauteng/U	2	200	Nat/NGO	1,122.5 Patient responding	Included but not unbundled	Included but not unbundled	Included but not unbundled	Included but not unbundled	3TC + d4T + EFV First-line treatment
						1,210.3 Patient not responding
		Eastern Cape/U	1	100	NGO	1,241.1 Patient responding
						1,177.3 Patient not responding
		Mpumalanga/R	1	100		1,229.4 Patient responding
						1,182.7 Patient not responding
	Vella V, et al. [21] 2008w	KwaZulu-Natal/U	32	2,835	Nat	1,068.1	500 (46.8%)	300 (28.1%)	236 (22.1%)	16.6 (1.5%)	NA

General: The tables are ordered alphabetically by country name and then by author. Dollar amounts and proportions of overall costs may not add to 100% due to rounding and because some of costs do not fit into the classifications used. For example, transportation costs to visit patients’ homes, non-ARV medicines, OI medicines, and recurrent costs such as cotton, syringes, gloves, etc. are in the “Other” category, which has been excluded from the table (but could be estimated subtracting the current total from 100%). ARV medicine costs include only the costs of antiretrovirals, mostly first-line unless otherwise noted in Regimen type. Personnel costs include human resources expenses incurred in services delivery, including health workers doing patient care and in some studies also administrative personnel. Laboratory costs may include HIV testing, CD4 cell count and viral load measurement. Overheads may include capital costs (medical equipment, computers) and/or recurrent costs (utilities: electricity, water, phone, rent, maintenance costs, storage, cleaning, or security). If the study reviewed provided details about what was included in each category, those details have been incorporated in the tables. Costs were converted into 2009 USD using average exchange rates during the study period (see sources in the Methods section).

City/setting: Refers to the city or area name and the type of location where the study took place, including U= Urban and R= Rural

Facilities: Refers to the number of facilities in which the costs were collected

Patients: Refers to the number of patients for whom cost data were collected for ART delivery

Provider type: Refers to the type of provider delivering ART: Nat=National; D=Donor; NGO= Non-government organization ; FBO= Faith-based organization

Regimen: Refers to the ARV line costed by the study. The acronyms for ARV drugs were taken from the World Health Organization classification: Cotrimoxazole = CTX; Didanosine = ddl; Efavirenz = EFV; Indinavir = IDV; Lamivudine = 3TC; Lopinavir = LPV; Nevirapine = NVP; Ritonavir =RTV; Saquinavir = SQV; Stavudine= d4T; Zidovudine = AZT

NA=Not available in the study reviewed.

^βThe study includes programmatic cost

^*The costs collected are financial costs.

Specific:

^aInternational dollars convert into USD using the purchase power parity conversion factor provided by the U.N. Statistical Office.^[61]

^bOutpatients only. It includes patients who are 15 years old and above.

^cThe study reports the median costs.

^fCosts calculated using patients retained “at the end of the study” as denominator.

^gThe study reports median costs.

^hCosts taken were for “first-line, annually thereafter” (i.e., first-line patients only, from their 6^th month after ART initiation onwards).

ⁱIncluding patients who started visiting the hospital in 1997, as it was not possible to single-out those patients who initiated ART after 2001.

^kPublic sector only, with patients paying a fixed portion of ART (included in the costs listed).

^lAnnual patient cost derived by multiplying cost per visit with an average number of visits per year. Because the hospital charged an extra 15%, we multiplied reported results obtain the actual cost of ART delivery.

^mStudy does not specify what “other” specialists or what “other” laboratory tests were costed out.

ⁿPatients who, every month throughout the study period, received ART. Costs presented cover patients through 2006, with only 41% having started after the year 2000.

^oCosts include patients who initiated ART in 2000, as it was not possible to single-out those patients who started after 2001.

^pCosts concern ART given for the treatment occurring between 6–12 months for first-line ART (patient specific) and separately for second-line treatment.

^rAverage between first year and second year of follow-up.

^sAverage between first year and second year of treatment.

^tIncludes patients who are 15 years old or above.

^wIncludes children: patients who are younger than 15 years of age.

For further details see the Supplementary Digital Content version of the tables.