Modelling the Cost of the National ART Programme under Different Sets of Guidelines: The National ART Cost Model (NACM) and the Treatment as Prevention Cost Model (TasP Cost Model)

On request of the South African Department of Health (NDoH), since 2009 HE²RO has used the detailled cost and outcomes data collected in other projects to develop mathematical models projecting the size of the treatment cohort under different scenarios of antiretroviral treatment (ART eligibility as well as the resulting costs). Our budget models, most notably the National ART Cost Model (NACM) and the Treatment as Prevention Cost Model (TasP Cost Model), have contributed to several sets of national treatment guideline changes, allowing ever increasing numbers of South Africans to initiate life-saving therapy while enabling the NDoH and National Treasury to plan for the necessary increases in the domestic funding envelope. These tools have also helped to estimate cost savings resulting from task-shifting from doctors to nurses, the opening of the South African antiretroviral drug tenders to international competition, and from the impact of large-scale treatment access on HIV transmission and incidence, all of which are now government policy. Beyond informing policy, the NACM has been used in calculating the cost of ART and PMTCT for the cost analysis of the National Strategic Plan for HIV/AIDS, STIs and TB 2011-2016, several rounds of funding proposals to the Global Fund for Malaria, AIDS and Tuberculosis, and its results have been used as inputs in a multitude of other models and economic analyses.