The costs and benefits of private sector provision of treatment to HIV-infected employees in Kampala, Uganda

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Abstract
Objectives: The objective of this study was to determine the financial incentives that companies have to treat HIV-infected employees, in a health care services company in Kampala, Uganda. Design: Cost–benefit analysis from the company's perspective of three interventions to treat HIV-infected employees. Methods: The costs and benefits of each intervention were compared with no intervention and with each other: cotrimoxazole prophylaxis (CTX) starting at WHO stage 2; highly active antiretroviral therapy (HAART) plus CTX starting at WHO stage 2; and a ‘hybrid’ strategy that begins with CTX at WHO stage 2 and later includes HAART. The 5-year health and economic outcomes were calculated using a Markov model. Inputs for disease progression rates and effects of HIV on company costs were derived from published and unpublished data and a survey administered to company officers. Results: The analysis showed that the ‘hybrid’ intervention is the most cost-effective. For 100 skilled employees it would save the company US$ 38 939 and 73 disability adjusted life-years (DALYs). For unskilled workers ‘CTX’ is the most cost effective and would saveUS$ 16 417 and 60 DALYs. ‘Hybrid’ has an incremental cost-effectiveness ratio of US$ 45 per DALY for unskilled workers whereas HAART is far less economical at an incremental cost per DALY of US$ 4118. For ‘CTX’, net savings are preserved across the full range of input values. Conclusion: A ‘hybrid’ intervention combining CTX prophylaxis followed by HAART would generate savings to a Ugandan company. Governments and other donors may find opportunities to share costs with the private sector as part of their phase-in strategy for antiretroviral therapy.

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