# \[e-drug\] Lancet: Cost-effectiveness of HIV/AIDS interventions in Africa

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**Created:** [May 12, 2002, 10:23am UTC](https://talk.edrugplus.org/t/e-drug-lancet-cost-effectiveness-of-hiv-aids-interventions-in-africa/14311 "2002-05-12T10:23:22Z")\
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E-drug: Lancet: Cost-effectiveness of HIV/AIDS interventions in Africa  
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[Copied as fair use. The article is available free on the website.  
[http://www.thelancet.com/journal/vol359/iss9318/full/llan.359.9318.original\_](http://www.thelancet.com/journal/vol359/iss9318/full/llan.359.9318.original_)  
research.21040.1  
or in pdf:  
[http://pdf.thelancet.com/pdfdownload?uid=llan.359.9318.original\_research.210](http://pdf.thelancet.com/pdfdownload?uid=llan.359.9318.original_research.210)  
40.1&x=x.pdf  
please repair the URL before clicking. KM]

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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