One of the first studies on cost effectiveness of antiretroviral therapy in Thailand, by the World Bank published in 2004, compared the cost effectiveness of government provision of free first line antiretroviral treatment only compared to first and second treatment.  The report recommended that provision of first line treatment while questioning the cost-effectiveness of including second line treatment. In July 2007, the authors reassessed their estimations, under a new assumption of a 90% decrease in the second line drug prices and concluded that provision of first and second line treatments was cost-effective and sustainable for Thailand. 

However, this modelling was based on a population model and efficacy data derived mostly from the literature on cohorts from non-Thai settings.  In addition, there has been major changes in price of antiretrovirals, since the Thai Government has made available generic second line drugs at a much lower price. The study aims to conduct a cost effectiveness analysis of first line compared to first and second line treatments based on primary data on the actual costs and efficacy within a cohort of adults receiving antiretroviral therapy as part of the PHPT-Oxfam Treatment program in community hospitals in Northern Thailand. The study will also incorporate quality of life assessments to allow for cost-utility analysis in terms of quality life years saved.

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