Economics of Antiretroviral Treatment vs. Circumcision for HIV Prevention
Bärnighausen, T., Bloom, D., and Humair, S. Proceedings of the National Academy of Sciences (December 2012), 109(52): 21271–21276.
This article reported on a model developed and applied in South Africa to compare the health effects and costs of scaling up treatment as prevention (TasP), expanded antiretroviral therapy (ART), and medical male circumcision (MMC) to prevent new HIV infections and avert deaths. The researchers defined TasP (initiating ART at CD4 cell count >350/μL) and ART (initiating ART at CD4 <350/μL) according to the World Health Organization definitions, and included optimistic assumptions about the programmatic effectiveness of TasP. The model showed that high ART coverage plus high MMC coverage provided roughly the same reduction in new HIV infections as TasP and cost some USD$5 billion less from 2009 to 2020. MMC was more cost-effective than ART in averting new infections, and similar in cost per death averted. TasP was significantly less cost-effective than either MMC or ART. In this model, which included recurrent costs but not start-up costs, the most cost-effective approach for reducing HIV mortality was to scale up MMC and ART together. The authors concluded that although TasP has been heralded as a “game changer,” continuing to scale up MMC and ART could have the same impact at significantly lower cost.