ABCDEFGHIJKLMNOPQRSTUV
1
SourceOptimisticBest guessPessimisticNote
2
Discount rateGiveWell CEA Nov 162.50%
Financial costs are discounted, health benefits are not
3
Benefits to patient
4
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
5
Life expectancy of an HIV patient with ARTMills et al 2011, see sheet 2 of this workbook27
6
Life years gained from ARTcalc18
7
8
DALY estimate for someone with HIV/AIDS, receiving ARTSalomon et al 2015 Pg. e7170.078
9
DALY estimate for someone with HIV/AIDS, not receiving ARTSalomon 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
10
11
YLD for HIV patient with ARTcalc2.1
12
YLD for HIV patient without ARTcalc3.9
13
YLD gained from ARTcalc1.7
14
15
DALYs averted from lifetime of ARTcalc19.7
16
Benefits of reduced transmission
17
Reduction in rate of transmissionBest guess. See "Does ART reduce the risk of HIV transmission?" section of GiveWell report; 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%
18
Additional cases of HIV averted by treating one person with ART
See Prevention model0.13
19
Total benefits
20
Value of a malaria death prevented for an individual 5 or older relative to that of a child younger than 5 (median parameter)GiveWell cost-effectiveness analyses November 20164
21
Value of extending an HIV patient's life for 18 years relative to preventing an adult malaria deathbest guess0.50.6250.75
22
Value of extending an HIV patient's life for 18 years relative to preventing a child malaria deathcalc2.5
23
24
Proportion of eligible people in SSA receiving ARTGiveWell VMMV cost-effectiveness model: "VMMC Extraction"69.52%
25
Value of averting a case of HIV relative to preventing a child malaria deathcalc; assumes only benefit is to those who would not have received ART0.76
26
Benefits from reduced transmission (relative to preventing child malaria deaths)
0.10
27
Costs
28
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 recent357480480
29
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%
30
Annual per person cost after accounting for imperfect adherence
calc623
31
Cost of lifetime of ARTcalc16818
32
Discounted cost of lifetime of ART (use this)12127
33
Cost-effectiveness
34
$/DALYcalc615
35
36
Cost per under-5 life saved equivalentcalc4669
37
GiveDirectly cost per under-5 life saved equivalent (median parameters)GiveWell cost-effectiveness analyses November 20167702
38
Multiple versus cashcalc1.6
39
Sources
40
41
van der Paal 2007
42
Mills et al 2011
43
Salomon et al 2015
44
Mirelman, Glassman, Temin 2016
45
Millions Saved
46
47
Recreating Mirelman, Glassman, Temin 2016
48
Deaths averted143637
49
Cost (USD)813000000
50
Cost per life saved equivalent5660
51
52
Cost per under-5 life saved equivalent2264.040602
53
Multiple versus cash3.4
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100