Cost and cost-effectiveness of antiretroviral therapy for HIV infection in Singapore

The objective of this study was to determine the cost and cost-effectiveness of antiretroviral therapy (ART) in Singapore. The use and cost of HIV services was calculated for patients managed at the national HIV referral centre in Singapore between 1996 and 2001 from a hospital perspective. Three groups of patients were compared by Centers for Disease Control and Prevention (CDC) stage of HIV infection: those who had never received ART; those who had received only dual therapy; and those who had only received highly active antiretroviral therapy (HAART). Hospital charges were used to estimate the average hospital inpatient and outpatient care costs. Life years gained (LYG) were calculated for different stages of HIV infection and the incremental costs per LYG were calculated comparing those on dual ART and HAART with those who did not receive ART. Patients on ART progressed less rapidly across all CDC stages. For CDC stage A, the incremental cost per LYG was $17,007 (Singaporean dollar) (interquartile range [IQR] $7963–25,113) and $22,511 (IQR $11,299–33,724) for those on dual therapy and HAART, respectively. The incremental cost per LYG in stage B was $10,868 (IQR $4506–17,239) and $21,094 (IQR $7774–34,431) for patients on dual therapy and HAART, respectively, while the incremental cost per LYG for stage C patients was $9,848 (IQR $5256–14,419) and $16,513 (IQR $8677–24,337) for dual therapy and HAART, respectively. Dual ART therapy and HAART were cost-effective interventions in Singapore. Cost-effectiveness is likely to improve if drug prices continue to decrease.