Abstract

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-Rath^1,2,3, J. Pienaar⁴, B. Brink⁵, A. van Zyl⁶, D. Muirhead⁶, A. Grant⁷, G. Churchyard⁶, C. Watts², P. Vickerman<sup>8

1</sup>Boston 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 ART	With ART	Difference to No ART
undiscounted
Total cost (millions)	363	331	-9%
Mean annual cost (millions)	18	17	-9%
Mean annual cost per HIV-positive employee	15,137	12,881	-15%
discounted
Total cost (millions)	282	257	-9%
Total annual cost (millions)	14	13	-9%
Mean annual cost per HIV-positive employee	11,792	10,003	-15%

[Table 1: Cost of HIV to company 2003-2022]

Cost item	Annual cost per item in 2006 USD (% of annual cost)		Difference to No ART (% of total savings)
	No ART	With 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 care	0.4 (9%)	0.3 (9%)	-0.1 (0.2%)
- of which outpatient care	1.1 (3%)	0.9 (3%)	-0.2 (6%)
Absenteeism	5.2 (42%)	4.6 (41%)	-0.6 (37%)
Benefits	5.0 (40%)	4.2 (37%)	-0.8 (48%)
Training and recruitment	0.7 (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.