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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”




CDC HIV/STD/TB Prevention News Update
Thursday, January 08, 2004
"Costs of Medical Services for Patients with HIV/AIDS in Khon
Kaen, Thailand"
AIDS (11.07.03) Vol. 17; P. 2375-2381::Tsutomu Kitajima; Yasuki
Kobayashi; Weerasak Chaipah; Hajime Sato; Witaya Chadbunchachai;
Ruengsin Thuennadee
     The authors undertook to estimate the savings and cost of
providing highly active antiretroviral therapy to adult patients
with AIDS under Universal Coverage (UC) in Khon Kaen, a rural
province in northeast Thailand. Although Thailand established
universal health insurance coverage in October 2001, HAART is not
included in the benefits. There has been demand that HAART be
added to the package so that every HIV/AIDS patient will have
access to the therapy regardless of economic status. As of 2000,
Thailand was estimated to have 695,000 HIV/AIDS patients.


     On the eve of National AIDS Day 2001, Thailand's Public
Health Minister announced that HAART would be included in the UC
benefit package in the future. The present study was conducted to
analyze the financial feasibility of implementing that decision.
     The researchers collected data at Khon Kaen Regional
Hospital and Northeast Regional Infectious Hospital on HIV/AIDS
patients who resided in the province, were more than 20 years
old, and made outpatient visits and/or were discharged from those
hospitals from Dec. 1, 2001 to Feb. 28, 2002. Using micro-costing
and cost modeling, the investigators estimated the average cost
per outpatient visit and inpatient day, and the cost of providing
HAART to adult patients with AIDS under UC province-wide at
outpatient settings.
     The authors found that the average cost per outpatient visit
with and without antiretroviral drugs was US$294.20 and US$26.10
respectively. The average cost per inpatient day with and without
ARV drugs was US$368.10 and US$43.80 respectively. HAART's net
annual cost was estimated to be US$5,674,629, the equivalent of
20 percent of the annual UC budget for adults in Khon Kaen.
     Based on their analyses, the authors concluded that a
substantial budget increase would be necessary to provide HAART
to all adult AIDS patients under UC. "However," they noted, "the
sensitivity analysis showed it would be an affordable policy
option if low-cost antiretroviral drugs were successfully


     A few months after this study was completed, the Government
Pharmaceutical Organization in Thailand started producing GPO-
VIR, a combination ARV pill that costs about a tenth of the
triple therapy regimen available at the time of this
investigation. Although the net cost of HAART could be much lower
than the initial estimate if GPO-VIR replaced the current
regimen, the investigators found that even with a 90 percent
reduction in drug cost, the cost of providing HAART was still
larger than the estimated savings from a reduction in
hospitalization, contrary to studies in developed countries.
     "This might be because of the differences in the labor cost
between Thailand and the developed countries," the researchers
     "The net cost of HAART is projected to be equivalent to
nearly half of the UC budget in this province in 2006," the study
said. "This indicates that adding HAART to the UC benefit package
would be prohibitively expensive.... However, if GPO-VIR could
successfully replace the current regimen, the proportion would be
8 percent in the same year."
     In situations in which affordable ARV drugs become widely
available, "it is envisaged that the kind of analysis that we
conducted in this study would be useful to assess the financial
implications of providing HAART in the public health system in
each country," the authors concluded.