8th international conference on psychosocial and economic aspects of hiv infection
TRANSCRIPT
8th International Conference on psychosocial and economic
aspects of HIV infectionwww.aidsimpact.net
Three levels of economic evaluation that should be
distinguished• 1 Economic calculus to identify optimal
strategies from the point of view of society
• 2 Determinants of variability of « real » practices
• 3 Evaluation of best public policies to reduce the gap between optimal and real practices
Plus chère, moins efficace
Stratégie dominée
Rejet
Moins chère, plus efficace
Stratégie dominante
Adoption
Coûts (+)
Résultat médical :efficacité, utilité
Classement coût/efficacité d’une stratégie nouvelle par rapport au standard médical de référence
Moins chère, moins efficace
Plus chère, plus efficace
Combien est-on prêt à perdre en efficacité pour réduire les coûts ?
Combien est-on prêt à payer en plus pour avoir
plus d’efficacité ?
(+)(-)
(-)
Cost-effectiveness analysis is a normative tool
• Appropriate to allocate resources between mutually exclusive strategies (= comparing different alternatives of reaching an identical goal)
• Examples:- Optimal CD4 level for initiating ARV therapy- Criteria for switching to 2nd line therapy- Best ARV combination for first-line therapy- Best monitoring for decentralized supply of ARV
Cost-effectiveness analysis is a normative tool
• A lot less appropriate to allocate resources between mutually compatible strategies (= comparing different programs with different goals)
• Examples:
- Prevention vs ARV therapy
- HIV care vs care of other pathologies
Cost-effectiveness analysis is not a management tool
• Absolutely not appropriate to understand why actual practices may have significant differences in productivity
• Econometric analysis and operational research are more appropriate tools
Scale and Average Unit Cost of VCT programs in 5 countries
1
10
100
1,000
1 10 100 1,000 10,000 100,000
Annual clients receiving VCTMexico Uganda Russia India South Africa
US
$ A
vera
ge U
nit C
osts
Source: Preliminary analysis of PANCEA data. Unpublished data. 2006