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The Impact of Company-Level ART Provision to a Mining Workforce in South Africa: A Cost-Benefit Analysis.

Meyer-Rath G, Pienaar J, Brink B, van Zyl A, Muirhead D, Grant A, Churchyard G, Watts C, Vickerman P - PLoS Med. (2015)

Bottom Line: As ART coverage increases from 10% to 97% of eligible employees, increases in survival and retention of HIV-positive employees and associated reductions in absenteeism and benefit payments lead to cost savings compared to a scenario of no treatment provision, with the annual cost of HIV to the company decreasing by 5% (90% credibility interval [CrI] 2%-8%) and the mean cost per HIV-positive employee decreasing by 14% (90% CrI 7%-19%) by 2022.This translates into an average saving of US$950,215 (90% CrI US$220,879-US$1.6 million) per year; 80% of these cost savings are due to reductions in benefit payments and inpatient care costs.Our analysis was limited to the direct cost of HIV to companies and did not examine the impact of HIV prevention policies on the miners or their families, and a few model inputs were based on limited data, though in sensitivity analysis our results were found to be robust to changes to these inputs along plausible ranges.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom; Center for Global Health and Development, Boston University, Boston, Massachusetts, United States of America; Health Economics and Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

ABSTRACT

Background: HIV impacts heavily on the operating costs of companies in sub-Saharan Africa, with many companies now providing antiretroviral therapy (ART) programmes in the workplace. A full cost-benefit analysis of workplace ART provision has not been conducted using primary data. We developed a dynamic health-state transition model to estimate the economic impact of HIV and the cost-benefit of ART provision in a mining company in South Africa between 2003 and 2022.

Methods and findings: A dynamic health-state transition model, called the Workplace Impact Model (WIM), was parameterised with workplace data on workforce size, composition, turnover, HIV incidence, and CD4 cell count development. Bottom-up cost analyses from the employer perspective supplied data on inpatient and outpatient resource utilisation and the costs of absenteeism and replacement of sick workers. The model was fitted to workforce HIV prevalence and separation data while incorporating parameter uncertainty; univariate sensitivity analyses were used to assess the robustness of the model findings. As ART coverage increases from 10% to 97% of eligible employees, increases in survival and retention of HIV-positive employees and associated reductions in absenteeism and benefit payments lead to cost savings compared to a scenario of no treatment provision, with the annual cost of HIV to the company decreasing by 5% (90% credibility interval [CrI] 2%-8%) and the mean cost per HIV-positive employee decreasing by 14% (90% CrI 7%-19%) by 2022. This translates into an average saving of US$950,215 (90% CrI US$220,879-US$1.6 million) per year; 80% of these cost savings are due to reductions in benefit payments and inpatient care costs. Although findings are sensitive to assumptions regarding incidence and absenteeism, ART is cost-saving under considerable parameter uncertainty and in all tested scenarios, including when prevalence is reduced to 1%-except when no benefits were paid out to employees leaving the workforce and when absenteeism rates were half of what data suggested. Scaling up ART further through a universal test and treat strategy doubles savings; incorporating ART for family members reduces savings but is still marginally cost-saving compared to no treatment. Our analysis was limited to the direct cost of HIV to companies and did not examine the impact of HIV prevention policies on the miners or their families, and a few model inputs were based on limited data, though in sensitivity analysis our results were found to be robust to changes to these inputs along plausible ranges.

Conclusions: Workplace ART provision can be cost-saving for companies in high HIV prevalence settings due to reductions in healthcare costs, absenteeism, and staff turnover. Company-sponsored HIV counselling and voluntary testing with ensuing treatment of all HIV-positive employees and family members should be implemented universally at workplaces in countries with high HIV prevalence.

No MeSH data available.


Related in: MedlinePlus

Prevalence by job grade, 2003–2022, with workplace ART provision.Job grade 1: unskilled worker; grades 2 and 3: semi-skilled worker; grades 4 and 5: skilled worker; grade 6: management.
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pmed.1001869.g003: Prevalence by job grade, 2003–2022, with workplace ART provision.Job grade 1: unskilled worker; grades 2 and 3: semi-skilled worker; grades 4 and 5: skilled worker; grade 6: management.

Mentions: Without ART, these survival rates lead to a total of 22,274 (90% CrI 20,887–24,086) HIV-positive employee-years (or life-years in employment) at the mines between 2003 and 2022, with HIV prevalence increasing from 13.3% (90% CrI 12.8%–14.4%) in 2010 to 14.3% (13.0%–15.9%) in 2022. With ART coverage increasing from 10% of eligible HIV-positive employees in 2003 to 97% in 2020, the number of deaths amongst employees due to HIV over 20 y decreases by 16% (90% CrI 11%–21%) from 1,583 (90% CrI 1,406–1,791) without ART to 1,336 (1,183–1,497) with ART. Survival in employment increases by 8% (90% CrI 6%–12%) to 24,134 (90% CrI 22,848–25,841) HIV-positive life-years. This increase is not larger because on average only 34% of HIV-infected employees are on ART at any given time (since only a fraction of HIV-infected employees are eligible for ART), only a portion of these would have left the workforce or died in absence of ART over this period, and some leave the workforce before realising the full benefit of treatment. The increase in survival leads to an increase in HIV prevalence from 14.3% (90% CrI 13.0%–15.9%) in 2022 without ART to 16.3% (14.9%–17.8%) with ART. HIV prevalence is always higher in the lower job grades: 21% (90% CrI 19%–22%) in job grade 1 and 21% (18%–24%) in job grade 2 in 2022 with ART (Fig 3).


The Impact of Company-Level ART Provision to a Mining Workforce in South Africa: A Cost-Benefit Analysis.

Meyer-Rath G, Pienaar J, Brink B, van Zyl A, Muirhead D, Grant A, Churchyard G, Watts C, Vickerman P - PLoS Med. (2015)

Prevalence by job grade, 2003–2022, with workplace ART provision.Job grade 1: unskilled worker; grades 2 and 3: semi-skilled worker; grades 4 and 5: skilled worker; grade 6: management.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556678&req=5

pmed.1001869.g003: Prevalence by job grade, 2003–2022, with workplace ART provision.Job grade 1: unskilled worker; grades 2 and 3: semi-skilled worker; grades 4 and 5: skilled worker; grade 6: management.
Mentions: Without ART, these survival rates lead to a total of 22,274 (90% CrI 20,887–24,086) HIV-positive employee-years (or life-years in employment) at the mines between 2003 and 2022, with HIV prevalence increasing from 13.3% (90% CrI 12.8%–14.4%) in 2010 to 14.3% (13.0%–15.9%) in 2022. With ART coverage increasing from 10% of eligible HIV-positive employees in 2003 to 97% in 2020, the number of deaths amongst employees due to HIV over 20 y decreases by 16% (90% CrI 11%–21%) from 1,583 (90% CrI 1,406–1,791) without ART to 1,336 (1,183–1,497) with ART. Survival in employment increases by 8% (90% CrI 6%–12%) to 24,134 (90% CrI 22,848–25,841) HIV-positive life-years. This increase is not larger because on average only 34% of HIV-infected employees are on ART at any given time (since only a fraction of HIV-infected employees are eligible for ART), only a portion of these would have left the workforce or died in absence of ART over this period, and some leave the workforce before realising the full benefit of treatment. The increase in survival leads to an increase in HIV prevalence from 14.3% (90% CrI 13.0%–15.9%) in 2022 without ART to 16.3% (14.9%–17.8%) with ART. HIV prevalence is always higher in the lower job grades: 21% (90% CrI 19%–22%) in job grade 1 and 21% (18%–24%) in job grade 2 in 2022 with ART (Fig 3).

Bottom Line: As ART coverage increases from 10% to 97% of eligible employees, increases in survival and retention of HIV-positive employees and associated reductions in absenteeism and benefit payments lead to cost savings compared to a scenario of no treatment provision, with the annual cost of HIV to the company decreasing by 5% (90% credibility interval [CrI] 2%-8%) and the mean cost per HIV-positive employee decreasing by 14% (90% CrI 7%-19%) by 2022.This translates into an average saving of US$950,215 (90% CrI US$220,879-US$1.6 million) per year; 80% of these cost savings are due to reductions in benefit payments and inpatient care costs.Our analysis was limited to the direct cost of HIV to companies and did not examine the impact of HIV prevention policies on the miners or their families, and a few model inputs were based on limited data, though in sensitivity analysis our results were found to be robust to changes to these inputs along plausible ranges.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom; Center for Global Health and Development, Boston University, Boston, Massachusetts, United States of America; Health Economics and Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

ABSTRACT

Background: HIV impacts heavily on the operating costs of companies in sub-Saharan Africa, with many companies now providing antiretroviral therapy (ART) programmes in the workplace. A full cost-benefit analysis of workplace ART provision has not been conducted using primary data. We developed a dynamic health-state transition model to estimate the economic impact of HIV and the cost-benefit of ART provision in a mining company in South Africa between 2003 and 2022.

Methods and findings: A dynamic health-state transition model, called the Workplace Impact Model (WIM), was parameterised with workplace data on workforce size, composition, turnover, HIV incidence, and CD4 cell count development. Bottom-up cost analyses from the employer perspective supplied data on inpatient and outpatient resource utilisation and the costs of absenteeism and replacement of sick workers. The model was fitted to workforce HIV prevalence and separation data while incorporating parameter uncertainty; univariate sensitivity analyses were used to assess the robustness of the model findings. As ART coverage increases from 10% to 97% of eligible employees, increases in survival and retention of HIV-positive employees and associated reductions in absenteeism and benefit payments lead to cost savings compared to a scenario of no treatment provision, with the annual cost of HIV to the company decreasing by 5% (90% credibility interval [CrI] 2%-8%) and the mean cost per HIV-positive employee decreasing by 14% (90% CrI 7%-19%) by 2022. This translates into an average saving of US$950,215 (90% CrI US$220,879-US$1.6 million) per year; 80% of these cost savings are due to reductions in benefit payments and inpatient care costs. Although findings are sensitive to assumptions regarding incidence and absenteeism, ART is cost-saving under considerable parameter uncertainty and in all tested scenarios, including when prevalence is reduced to 1%-except when no benefits were paid out to employees leaving the workforce and when absenteeism rates were half of what data suggested. Scaling up ART further through a universal test and treat strategy doubles savings; incorporating ART for family members reduces savings but is still marginally cost-saving compared to no treatment. Our analysis was limited to the direct cost of HIV to companies and did not examine the impact of HIV prevention policies on the miners or their families, and a few model inputs were based on limited data, though in sensitivity analysis our results were found to be robust to changes to these inputs along plausible ranges.

Conclusions: Workplace ART provision can be cost-saving for companies in high HIV prevalence settings due to reductions in healthcare costs, absenteeism, and staff turnover. Company-sponsored HIV counselling and voluntary testing with ensuing treatment of all HIV-positive employees and family members should be implemented universally at workplaces in countries with high HIV prevalence.

No MeSH data available.


Related in: MedlinePlus