Open Access Research article

Estimating age-based antiretroviral therapy costs for HIV-infected children in resource-limited settings based on World Health Organization weight-based dosing recommendations

Kathleen Doherty1*, Shaffiq Essajee23, Martina Penazzato4, Charles Holmes5, Stephen Resch6 and Andrea Ciaranello7*

Author Affiliations

1 Medical Practice Evaluation Center, Divisions of General Medicine, Massachusetts General Hospital, Boston, MA, USA

2 Department of Pediatrics, New York University School of Medicine, New York, NY, USA

3 Clinton Health Access Initiative, Boston, MA, USA

4 Clinical Trial Unit Medical Research Council, London, UK

5 Center for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia

6 Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA

7 Medical Practice Evaluation Center, Divisions of General Medicine and Infectious Disease, Massachusetts General Hospital, Boston, MA, USA

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BMC Health Services Research 2014, 14:201  doi:10.1186/1472-6963-14-201

Published: 2 May 2014



Pediatric antiretroviral therapy (ART) has been shown to substantially reduce morbidity and mortality in HIV-infected infants and children. To accurately project program costs, analysts need accurate estimations of antiretroviral drug (ARV) costs for children. However, the costing of pediatric antiretroviral therapy is complicated by weight-based dosing recommendations which change as children grow.


We developed a step-by-step methodology for estimating the cost of pediatric ARV regimens for children ages 0–13 years old. The costing approach incorporates weight-based dosing recommendations to provide estimated ARV doses throughout childhood development. Published unit drug costs are then used to calculate average monthly drug costs. We compared our derived monthly ARV costs to published estimates to assess the accuracy of our methodology.


The estimates of monthly ARV costs are provided for six commonly used first-line pediatric ARV regimens, considering three possible care scenarios. The costs derived in our analysis for children were fairly comparable to or slightly higher than available published ARV drug or regimen estimates.


The methodology described here can be used to provide an accurate estimation of pediatric ARV regimen costs for cost-effectiveness analysts to project the optimum packages of care for HIV-infected children, as well as for program administrators and budget analysts who wish to assess the feasibility of increasing pediatric ART availability in constrained budget environments.

Antiretroviral therapy; Pediatric HIV; Costs