8. Conclusions

The analysis indicates that high costs are associated with the provision of ARV therapy. The drugs themselves are easily the most important cost component. The large costs associated with therapy, in combination with the number of people eligible for such therapy, appear to make provision of ARVs unaffordable in many parts of the world at present. However, ARV therapy does appear affordable and cost-effective in high-income countries, where it may also be cost-saving when given as prophylaxis to HIV-infected pregnant women. ARV therapy does not appear to be either cost-saving or cost-effective in a developing country context, and this is true for prophylaxis to pregnant women as well as more general provision to HIV-infected individuals. Prophylaxis for health workers does not appear particularly cost-effective in any region. For all except the wealthiest individuals, financing of therapy is likely to depend on public sector provision.

A few notes of caution concerning these conclusions are, however, warranted. It is possible that ARV therapy may become much more affordable in time, as bulk-purchase arrangements become more commonplace, and as partnerships are established among international agencies, governments and drug companies. It is also conceivable that lower drug dosages may be discovered to be as effective as those currently recommended, and that drug companies may be able to reduce their prices once the costs of drug development have been recouped. Nevertheless, the framework of analysis developed above should be useful for informing current policy development, for enabling individual countries to analyse their own current situation vis a vis ARV therapy, and for the generation of cost analyses under different assumptions concerning drug costs.