E-drug: Lancet: Cost-effectiveness of HIV/AIDS interventions in Africa
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Lancet 2002; 359: 1635-42 (11 May 2002)
Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review
of the evidence
Andrew Creese, Katherine Floyd, Anita Alban, Lorna Guinness
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Essential Drugs and Medicines Policy Department (A Creese BPhil), and Stop
Tuberculosis Department (K Floyd PhD), WHO, Geneva, Switzerland; University
of Copenhagen, Denmark (A Alban MSc); and London School of Hygiene and
Tropical Medicine, UK (L Guinness MSc)
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Correspondence to: Mr Andrew Creese (e-mail:creesea@who.ch)
Summary
Background Evidence for cost-effectiveness of interventions for HIV/AIDS in
Africa is fragmentary. Cost-effectiveness is, however, highly relevant.
African governments face difficult choices in striking the right balance
between prevention, treatment, and care, all of which are necessary to deal
comprehensively with the epidemic. Reductions in drug prices have raised the
priority of treatment, though treatment access is restricted. We assessed
the existing cost-effectiveness data and its implications for
value-for-money strategies to combat HIV/AIDS in Africa.
Methods We undertook a systematic review using databases and consultations
with experts. We identified over 60 reports that measured both the cost and
effectiveness of HIV/AIDS interventions in Africa. 24 studies met our
inclusion criteria and were used to calculate standardised estimates of the
cost (US$ for year 2000) per HIV infection prevented and per
disability-adjusted life-year (DALY) gained for 31 interventions.
Findings Cost-effectiveness varied greatly between interventions. A case of
HIV/AIDS can be prevented for $11, and a DALY gained for $1, by selective
blood safety measures, and by targeted condom distribution with treatment of
sexually transmitted diseases. Single-dose nevirapine and short-course
zidovudine for prevention of mother-to-child transmission, voluntary
counselling and testing, and tuberculosis treatment, cost under $75 per DALY
gained. Other interventions, such as formula feeding for infants, home care
programmes, and antiretroviral therapy for adults, cost several thousand
dollars per infection prevented, or several hundreds of dollars per DALY
gained.
Interpretation A strong economic case exists for prioritisation of
preventive interventions and tuberculosis treatment. Where potentially
exclusive alternatives exist, cost-effectiveness analysis points to an
intervention that offers the best value for money. Cost-effectiveness
analysis is an essential component of informed debate about priority setting
for HIV/AIDS.
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