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Towards an improved investment approach for an effective response to HIV/AIDS |
Schwartlander B, Stover J, Hallett T, Atun R, Avila C, Gouws E, Bartos M, Ghys PD, Opuni M, Barr D, Alsallaq R, Bollinger L, de Freitas M, Garnett G, Holmes C, Legins K, Pillay Y, Stanciole AE, McClure C, Hirnschall G, Laga M, Padian N, Investment Framework Study Group |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary This study examined the costs and health outcomes for a framework of investment strategies for the global prevention of and response to HIV and AIDS transmission. The authors concluded that the investment framework was cost-effective, and the additional investment was mainly offset by the savings in treatment costs. The methods appear to have been satisfactory and it appears that the authors' conclusions are appropriate, but the online appendices should be checked to fully assess the study's quality. Type of economic evaluation Cost-effectiveness analysis Study objective The aim was to examine the costs and health outcomes for a framework of investment strategies in the global prevention of and response to HIV and AIDS transmission. Interventions The investment strategies consisted of: basic programme activities, such as condom promotion and distribution, behaviour change programmes, and treatment and support for people with HIV or AIDS; critical enablers, such as political commitment, mass media campaigns, and programme management and incentives; and synergies with development sectors, such as education, legal reforms, and gender equality. This was compared with the existing interventions and HIV investments levels. Location/setting Multinational/primary and secondary care. Methods
Analytical approach:A modelling approach was used to estimate the investment resources for 139 low- or middle-income countries, from 2011 onwards. The authors did not explicitly state the perspective. The time horizons were from 2011 to 2015 or 2020.
Effectiveness data:The effectiveness estimates included total HIV infections, infant and child infections, survival time, and deaths. The effectiveness data were from an extensive literature review for the prevention interventions (Bollinger, et al. 2008, see ‘Other Publications of Related Interest’ below for bibliographic details). An impact matrix was constructed to classify these data. The achievement of target coverage was closely dependent on the resources invested and the targets set by the United Nations General Assembly Special Session on HIV/AIDS in 2001.
Monetary benefit and utility valuations:Not relevant.
Measure of benefit:The measures of benefit were the life-years saved, and the infections and deaths averted. All were discounted at 3% per annum.
Cost data:The programme costs were detailed in an online appendix. The unit costs were from published literature and the opinions of a multinational workshop of HIV experts from 58 countries. Demographic data from the United Nations Population Division and epidemiologic projection models were used to determine the number of patients requiring treatment for each country, which was used to weight the cost estimates. Regional averages were used for unknown costs or resources. The costs were presented in US dollars ($) and were discounted at 3% per annum.
Analysis of uncertainty:None reported. Results The total basic programme costs were $7.0 billion in 2011, $12.9 billion in 2015, and $10.6 billion in 2020. The total critical enabler costs were $5.9 billion in 2011, $3.4 billion in 2015, and $3.7 billion in 2020. The costs for synergies with development sectors were $3.6 billion in 2011, $5.8 billion in 2015, and $5.4 billion in 2020.
The total incremental costs, from 2011 to 2020, for the full investment framework, were $46.5 billion. The present value of avoided costs for the treatment of HIV infections was $40 billion.
For the period 2011 to 2020, the investment framework was estimated to prevent 12.2 million HIV infections, 1.9 million of which were infant or child infections. It gained 29.4 million life-years and averted 7.4 million deaths.
The estimated incremental cost was $1,060 per life-year gained, $4,090 per death averted, or $2,450 per infection averted. The cost per life-year gained was highly cost-effective at less than the per capita gross domestic product of the world's poorest region. Authors' conclusions The authors concluded that the proposed investment framework was cost-effective, and the additional investment was mainly offset by the savings in treatment costs. CRD commentary
Interventions:The three strategies within the investment framework were well described and referenced. The online appendices should be consulted for the details of the individual components and the resources required.
Effectiveness/benefits:The details of the programme effectiveness source studies were not provided, which makes it difficult to assess their quality. These studies were referenced and should be consulted to assess their internal validity. The effectiveness (impact of the prevention interventions) was reported in an impact matrix, with some results in the text. The sources appear to have been mainly United Nations reports, as well as relevant studies, and expert opinion for the success and target levels of the programme components.
Costs:The perspective was not explicitly stated, but appears to have been that of the investment providers, such as governments and the Global Fund to Fight AIDS, TB and Malaria. The online appendices included extensive information on the costs including their sources. These appendices should be consulted to assess the validity of these data. Some assumptions were made for the unit costs and these were justified by the authors. The costs were appropriately discounted. The price year was not explicitly reported, but might have been 2011.
Analysis and results:Sufficient details were provided on the investment framework model and the results were adequately described. The authors discussed their findings in relation to the high level United Nations meetings and enhanced integration and strategic responses to previous targets. They discussed the uncertainty in, for example, the scaling up of various targets, due to varying national circumstances, local translation factors, and international financiers. They highlighted the assumptions needed for their model, such as for the capacity for communities to increase their role in HIV and AIDS control.
Concluding remarks:The methods appear to have been satisfactory and it appears that the authors' conclusions are appropriate, but the online appendices should be checked to fully assess the study's quality. Bibliographic details Schwartlander B, Stover J, Hallett T, Atun R, Avila C, Gouws E, Bartos M, Ghys PD, Opuni M, Barr D, Alsallaq R, Bollinger L, de Freitas M, Garnett G, Holmes C, Legins K, Pillay Y, Stanciole AE, McClure C, Hirnschall G, Laga M, Padian N, Investment Framework Study Group. Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 2011; 377(9782): 2031-2041 Other publications of related interest Bollinger LA. How can we calculate the "E" in "CEA"? AIDS 2008; 22(Supplement 1): S51-S57. Indexing Status Subject indexing assigned by NLM MeSH Acquired Immunodeficiency Syndrome /drug therapy /economics /epidemiology /prevention & Developing Countries; Financing, Government; HIV Infections /drug therapy /economics /epidemiology /prevention & Health Policy; Humans; International Cooperation; Pakistan /epidemiology; South Africa /epidemiology; control; control AccessionNumber 22011001086 Date bibliographic record published 17/08/2011 Date abstract record published 26/01/2012 |
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