XIX International AIDS Conference


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TULBE05 - Oral Abstract

Dramatic increases in population life expectancy and the economic value of ART in rural South Africa

Presented by Jacob Bor (United States).

J. Bor1,2, A.J. Herbst2, M.-L. Newell2,3, T. Bärnighausen1,2

1Harvard School of Public Health, Global Health and Population, Boston, United States, 2Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa, 3Centre for Paediatric Epidemiology and Biostatistics, University College of London Institute of Child Health, London, United Kingdom

Background: Large increases in adult life expectancy are anticipated in HIV endemic regions, due to antiretroviral treatment (ART). Such changes may have important implications for economic decision-making on the part of individuals and governments.
Methods: We estimate adult life expectancy (15+e15) annually for 2000-2011 using data from a large population cohort in rural South Africa (n=149,640), a population where 28% of adults were infected with HIV in 2011. We assess the distribution of life spans in 2003, prior to the public sector roll out of ART in South Africa, and in 2011. We use observed changes in adult life expectancy to compute a cost-benefit ratio for government provision of ART in this setting.
Results: After declining in the early 2000s, adult life expectancy in the population cohort increased from 52 years in 2003 to 61 years in 2011 (Figure 1); gains were larger for women (9.5 years) than for men (6.6 years). Changes in the distribution of lifespans reveal a substantial shift towards older ages (Figure 2). Applying standard estimates of the value of a statistical life-year (1-3 times per capita GDP), ART roll-out in this community has led to lifetime gains of $26,000 to $77,000 per capita. This is 2-6 times larger than the per capita cost of providing lifelong ART to every person who contracts HIV in this community, which we estimate at $13,400, based on 2012 cost figures from the President´s Emergency Plan for AIDS Relief.
Conclusions: ART roll-out has resulted in large increases in adult life expectancy in rural South Africa. The economic value of these health gains far outweighs the costs of treatment. Future research is needed to understand how people perceive these changes in longevity, and how these changes affect attitudes, such as fatalism, and behaviors, such as healthcare-seeking, risk-taking, and educational choices.

Figure 1, Adult life expectancy, 2000-2011
[Figure 1, Adult life expectancy, 2000-2011]

Figure 2, Distribution of Lifespans, 2003 and 2011
[Figure 2, Distribution of Lifespans, 2003 and 2011]

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