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Table 2 Summary of economic results

From: Needle and syringe programs in Yunnan, China yield health and financial return

  

2002-2008

2002-Lifetime

Cumulative number of cases

 

W/o NSPs

With NSPs

Averted

W/o NSPs

With NSPs

Averted

DALYsa

(SF = 2.5)

44,391

43,007

1,384

128,879

116,126

12,753

 

(SF = 4.0)

76,606

74,628

1,978

225,854

207,582

18,272

HIV incidence

(SF = 2.5)

25,975

20,712

5,263

25,975

20,712

5,263

 

(SF = 4.0)

45,511

37,970

7,541

45,511

37,970

7,541

Number of total infected patients in 2008

(SF = 2.5)

35,741

30,998

4,743

35,741

30,998

4,743

 

(SF = 4.0)

63,111

56,313

6,797

63,111

56,313

6,797

Number of patients on ART in 2008

(SF = 2.5)

1,800

1,739

61

1,800

1,739

61

 

(SF = 4.0)

3,107

3,020

87

3,107

3,020

87

Number of TE patients (person-years)

(SF = 2.5)

58,664

57,815

849

174,166

158,819

15,347

 

(SF = 4.0)

100,675

99,462

1,213

304,298

282,308

21,990

Number of patients on ART (person-years)

(SF = 2.5)

3,083

3,025

58

68,004

60,483

7,522

 

(SF = 4.0)

5,307

5,224

83

119,487

108,710

10,777

Governmental investment (millions, in 2009 dollars with 3% discount)

Total NSP investmentb

 

--

$1.04 m

--

--

$1.04 m

--

Expenses stratified by service items

       

   Viral load testsc

(SF = 2.5)

$1.03 m

$1.01 m

$0.02 m

$15.43 m

$13.86 m

$1.57 m

 

(SF = 4.0)

$1.77 m

$1.74 m

$0.03 m

$27.06 m

$24.81 m

$2.25 m

   CD4 load testsd

(SF = 2.5)

$21.96 m

$21.10 m

$0.85 m

$50.80 m

$45.97 m

$4.83 m

 

(SF = 4.0)

$38.00 m

$36.78 m

$1.22 m

$88.99 m

$82.07 m

$6.92 m

   Provision of ARTe

(SF = 2.5)

$10.29 m

$10.09 m

$0.19 m

$154.31 m

$138.57 m

$15.74 m

 

(SF = 4.0)

$17.71 m

$17.43 m

$0.27 m

$270.60 m

$248.05 m

$22.55 m

   Subsidies on Treatment of OIsf

(SF = 2.5)

$26.40 m

$26.04 m

$0.36 m

$61.77 m

$57.14 m

$4.63 m

 

(SF = 4.0)

$45.29 m

$44.77 m

$0.51 m

$107.59 m

$100.95 m

$6.63 m

   Subsidies on Chinese herbal treatmentg

(SF = 2.5)

$1.24 m

$1.23 m

$0.02 m

$2.91 m

$2.69 m

$0.22 m

 

(SF = 4.0)

$2.13 m

$2.11 m

$0.02 m

$5.06 m

$4.75 m

$0.31 m

   Total expenses associated with infection

(SF = 2.5)

$60.91 m

$59.47 m

$1.44 m

$285.22 m

$258.23 m

$26.99 m

 

(SF = 4.0)

$104.89 m

$102.83 m

$2.06 m

$499.30 m

$460.63 m

$38.66 m

Expenses stratified by target groups

       

   Expenses on HIV asymptomatic patientsh

(SF = 2.5)

$14.86 m

$14.11 m

$0.75 m

$26.90 m

$24.09 m

$2.80 m

 

(SF = 4.0)

$25.82 m

$24.74 m

$1.08 m

$47.26 m

$43.24 m

$4.02 m

   Expenses on AIDS patientsi

(SF = 2.5)

$34.16 m

$33.70 m

$0.46 m

$79.94 m

$73.95 m

$5.99 m

 

(SF = 4.0)

$58.61 m

$57.94 m

$0.66 m

$139.23 m

$130.65 m

$8.58 m

   Expenses on AIDS patients on ARTj

(SF = 2.5)

$11.89 m

$11.67 m

$0.22 m

$178.38 m

$160.19 m

$18.19 m

 

(SF = 4.0)

$20.47 m

$20.15 m

$0.32 m

$312.81 m

$286.75 m

$26.06 m

   Total expenses associated with infection

(SF = 2.5)

$60.91 m

$59.47 m

$1.44 m

$285.22 m

$258.23 m

$26.99 m

 

(SF = 4.0)

$104.89 m

$102.83 m

$2.06 m

$499.30 m

$460.63 m

$38.66 m

Cost Benefit Analysis

       

   Cost/DALY averted

(SF = 2.5)

 

$753

  

$82

 
 

(SF = 4.0)

 

$527

  

$57

 

   Benefit-cost ratio (ratio of expenses saved to investment)

(SF = 2.5)

 

1.38

  

25.89

 
 

(SF = 4.0)

 

1.97

  

37.09

 

   Cost/Infection averted

(SF = 2.5)

 

$198

  

$198

 
 

(SF = 4.0)

 

$138

  

$138

 
  1. a. The cumulative numbers of DALYs are calculated based on the values of health utilities at different disease stages. Health utilities among asymptomatic people living HIV, people at AIDS stage and patients receiving ART are 0.88 (0.82-0.94) [76, 77], 0.64 (0.58-0.70) [77] and 0.78 (0.76-0.80) [76, 78] respectively.,
  2. b. The costs of NSPs during the period 2002-2008 is calculated by multiplying the average unit expense of distributing a syringe ($0.11 USD), which incorporates and averages over all necessary infrastructure, personnel, marketing and recurring service costs [33], to the estimated total number of syringes distributed (8.75 × 106).
  3. c. Regular viral load monitoring is currently undertaken once a year for HIV/AIDS patients on ART to monitor potential change in viral load. Its cost is hence the product of the number of patients on ART and its unit cost (~USD$300/person [79, 80]) and is calculated with 3% value discounting.
  4. d. CD4 load tests are performed quarterly for patients on ART [80–82] and twice a year for people diagnosed with HIV but not on ART [80, 82]. The unit cost of CD4 load test is USD $42 [83]. The total cost is calculated with 3% discounting.
  5. e. The annual cost of ART for each AIDS patient is approximately USD $3000 [83–86], which is multiplied by the number of patients on ART to obtain the total cost. The total cost is calculated with and without value discounting.
  6. f. Each year, the government subsidizes approximately USD $340 [87] of healthcare associated with opportunistic infections of symptomatic AIDS patients (those that are in the treatment-eligible stage or potentially on ART (but experienced treatment failure) in our model). Its total yearly spending is calculated as the product of the two with 3% value discounting.
  7. g. Each year, the government subsidizes approximately USD $16 [87] of herbal treatment for each symptomatic AIDS patient (treatment-eligible patients and patients on ART). Its total yearly spending is calculated as the product of the two with and without value discounting.
  8. h. Each HIV asymptomatic patients are CD4 tested twice a year [80, 82], the governmental investment on each individual HIV patients is USD$42 × 2 = USD$84. This amount is multiplied by the total number of asymptomatic patients and then summed with the cost of one-off diagnosis testing of newly infected cases to result in the total governmental investment in this specific target group.
  9. i. Each HIV-infected patient yet to receive ART will receive CD4 testing twice each year [80, 82]. Treatment of opportunistic infections and Chinese herbal treatment for AIDS are also covered or subsidized by the government [87].
  10. Each patient on ART will receive 1 viral test and 4 CD4 tests each year [79–82]. In addition to government-subsidized treatment for opportunistic infections and herbal treatment for AIDS, they also receive ART on governmental expenses [85].
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BMC Public Health

ISSN: 1471-2458

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