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SourceOptimisticBest guessPessimisticNote
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Discount rateGiveWell 2020 Cost-effectiveness Analysis - version 24.00%
Financial costs are discounted, health benefits are not
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Benefits to patient
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Life expectancy of an HIV patient without ART"For incident HIV cases the median survival from seroconversion to death was 9.0 years (95% CI 7.5, 10.6). Removing background mortality (as measured in the HIV-negative population) from the mortality experience of the HIV-positive individuals yielded an estimate for net mortality attributable to HIV that would correspond to a median survival of 10.2 years." van der Paal 20079
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Life expectancy of an HIV patient with ARTMills et al 2011, see sheet 2 of this workbook27
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Life years gained from ARTcalc18
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Units of value assigned to 1 YLL gainedGiveWell 2020 moral weights explainer2.30
Rough estimate. 2.3 is the average value of an additional year of life for people over the age of 10 in our model.
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Units of value from YLLs gainedcalc41.35
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DALY estimate for someone with HIV/AIDS, receiving ART
Salomon et al 2015 Pg. e7170.078
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DALY estimate for someone with HIV/AIDS, not receiving ART
Salomon et al 2015 Pg. e717; "we average the DALY weight for "HIV: symptomatic, pre-AIDS" (0.274) with the DALY weight for "AIDS: not receiving antiretroviral treatment" (0.582)"0.428
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YLD for HIV patient with ARTcalc2.1
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YLD for HIV patient without ARTcalc3.9
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YLD gained from ARTcalc1.7
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Units of value assigned to averting 1 YLD2020 moral weights explanation document2.30
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Units of value from YLDs avertedcalc4.02
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DALYs averted from lifetime of ARTcalc19.7
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Total units of value generated from lifetime of ART, for patientcalc45.37
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Benefits of reduced transmission
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Reduction in rate of transmissionBest guess. 75% chosen as a compromise between single RCT and multiple cohort studies, adjusted downwards to account for not all infections being sexually transmitted96%75%42%
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Additional cases of HIV averted by treating one person with ART
See Prevention model0.17
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Proportion of eligible people in SSA receiving ARTGiveWell VMMV cost-effectiveness model: "VMMC Extraction"69.52%
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Value assigned to averting a case of HIVcalc7.78
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Total units of value generated from reduced transmission, per patient treatedcalc2.37
assumes only benefit is to those who would not have received ART
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Total benefits
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Value of a malaria death prevented for an individual 5 or older relative to that of a child younger than 5Updated Feb 2021. This value is derived from the values we assign to preventing deaths from malaria in our 2020 Cost-effectiveness Analysis - version 20.72
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Value of extending an HIV patient's life for 18 years relative to preventing a the death of an individual over 5 from malariabest guess0.50.630.75
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Value of extending an HIV patient's life for 18 years relative to preventing a child malaria deathcalc0.45
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Total units of value generated, per patient treatedcalc47.74
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Costs
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Annual per person cost of delivering anti-retroviral therapy
"In 2014, treatment costs for the national ART program were estimated at US$480 per person.[14] This cost is expected to rise to US$600 per person by 2030" Million Saved; "The Masa program costs $357 per patient for the government in 2011 [40]." Mirelman, Glassman, Temin 2016". We chose the 2014 estimate because it was more recent$357$480$480
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Proportion of patients who adhere to ART“Our pooled analysis of African studies (12 116 patients total) indicated a pooled estimate of 77% (95% confidence interval, 68%-85%; I2, 98.4%).” Mills 2006, P 67977.00%
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Annual per person cost after accounting for imperfect adherence
calc$623
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Cost of lifetime of ARTcalc$16,818
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Discounted cost of lifetime of ART (use this)$10,175
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Cost-effectiveness
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$/DALYcalc$516
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Total units of value generated with hypothetical donation ($100,000) to ART programcalc469.20
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Total units of value generated with hypothetical donation ($100,000) to GiveDirectly (unconditional cash transfers)2020 Cost-effectiveness Analysis - version 2344.00
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Antiretroviral therapy versus cashcalc1.4
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Sources
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van der Paal 2007
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Mills et al 2011
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Salomon et al 2015
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Mirelman, Glassman, Temin 2016
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Millions Saved
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Recreating Mirelman, Glassman, Temin 2016
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Deaths avertedMirelman, Glassman, Temin 2016143,637.00
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Cost (USD)Mirelman, Glassman, Temin 2016$813,000,000
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Cost per life savedcalc$5,660
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Cost per outcome as good as averting the death of an individual under 5 from malaria
calc$12,614
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Value assigned to averting the death of an individual under 5 from malaria2020 Cost-effectiveness Analysis - version 2117.00
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Total units of value generated with hypothetical donation ($100,000) to ART programcalc927.55
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Antiretroviral therapy versus cashcalc2.7
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Note: This CEA was created in August 2018 (original version here). Moral weights were updated in February 2021
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