XIX International AIDS Conference

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MOAE0203 - Oral Abstract Session


Company-level ART provision to employees is cost saving: a modelled cost-benefit analysis of the impact of HIV and antiretroviral treatment in a mining workforce in South Africa

Presented by Peter Vickerman (United Kingdom).

G. Meyer-Rath1,2,3, J. Pienaar4, B. Brink5, A. van Zyl6, D. Muirhead6, A. Grant7, G. Churchyard6, C. Watts2, P. Vickerman8


1Boston University Center for Global Health and Development, Boston, United States, 2London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, London, United Kingdom, 3University of the Witwatersrand, Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa, 4Highveld Hospital, Thermal Coal, Emhalahleni, South Africa, 5Anglo American, Johannesburg, South Africa, 6The Aurum Institute, Johannesburg, South Africa, 7London School of Hygiene and Tropical Medicine, Department of Clinical Research, London, United Kingdom, 8London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, United Kingdom

Background: HIV impacts heavily on rates of absenteeism, labour force turnover and, ultimately, cost of operations of companies in sub-Saharan Africa. Employers increasingly supply HIV testing and antiretroviral treatment (ART) programmes at the workplace. The full economic impact of ART provision on a mining workforce has not yet been analysed.
Methods: We developed a dynamic health-state transition model to analyse the economic impact of HIV and the cost benefit of ART provision in a mining company in South Africa between 2003 and 2022. The model was fitted to the workplace using information on the size, composition, turnover, HIV prevalence and CD4+ counts of the workforce from company records. Bottom-up analyses of economic costs at the company supplied data on inpatient and outpatient resource utilisation and the costs of absenteeism and replacing a sick worker. Costs are analysed from the company perspective and presented undiscounted and discounted at 5%.
Results: As a result of lower mortality and morbidity in the employees covered by ART, survival in employment of HIV-positive employees grows by 7% as ART coverage increases from 21% to 80% of eligible HIV-positive employees by 2022. The associated reduction in absenteeism and benefit payments more than offsets the additional cost of the ART programme, leading to a 9% decrease in the total and annual cost of HIV to the company and a 15% decrease in the mean cost per HIV-positive employee by 2012 (Table 1). 48% and 37% of cost savings are due to reductions in benefits and absenteeism, respectively (Table 2). Savings to the company average USD 1.1 million per year. Total HIV-related costs equal 1.5 to 3.5% of payroll.


Cost (2010 USD)No ARTWith ARTDifference to No ART
undiscounted
Total cost (millions)363331-9%
Mean annual cost (millions)1817-9%
Mean annual cost per HIV-positive employee15,13712,881-15%
discounted
Total cost (millions)282257-9%
Total annual cost (millions)1413-9%
Mean annual cost per HIV-positive employee11,79210,003-15%
[Table 1: Cost of HIV to company 2003-2022]




Cost itemAnnual cost per item in 2006 USD (% of annual cost)Difference to No ART (% of total savings)
 No ARTWith ART 
ART programme cost-0.6 (5%)+0.6 (-)
Medical care (inpatient and outpatient)1.4 (12%)1.3 (12%)-0.1 (6%)
- of which inpatient care0.4 (9%)0.3 (9%)-0.1 (0.2%)
- of which outpatient care1.1 (3%)0.9 (3%)-0.2 (6%)
Absenteeism5.2 (42%)4.6 (41%)-0.6 (37%)
Benefits5.0 (40%)4.2 (37%)-0.8 (48%)
Training and recruitment0.7 (6%)0.6 (5%)-0.1 (9%)
[Table 2: Mean annual cost per item 2003-2022]


Conclusions: ART provision at the workplace level is cost-saving for the company. Our results point to private-sector ART provision as a viable alternative to overburdened public sector ART programmes.


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