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Open Access Publications from the University of California

Cost-Effectiveness of HIV Interventions for Resource Scarce Countries: Setting Priorities for HIV/AIDS


Objectives: Despite recent foundation donations and bilateral commitments there are insufficient funds to implement all of the desired interventions for AIDS prevention and treatment. This paper explores one methodto analyze the allocation of limited budgets. Methods: Based on existing data from African countries, we compare the cost-effectiveness of both HIV prevention and treatment interventions using cost per life-year saved as the outcome measure. We examined five prevention interventions: (1) voluntary counseling and testing; (2) prevention of mother-to-child transmission; (3) STD mass treatment for general population; (4) STD management for sex workers; and (5) blood screening – and four drug price scenarios for antiretroviral treatment for HIV+ patients. In a hypothetical country of one million people and a generalized epidemic, we performed a static budgetary simulation with constrained resources to estimate total life-years gained and number of HIV cases prevented/treated with only prevention or treatment interventions. Results: Both the cost-effectiveness analysis and the budgetary analysis suggest that HIV prevention interventions are much more cost-effective than ARV treatment. Both blood screening and STD control among sex workers are the most cost-effective preventative interventions at the costs of $3.35 and $3.95 per life-year saved (LYS), respectively. ARV treatment is the least cost-effective, costing $1,317.20 per life-year saved at generic drug prices. In the budgetary simulation scenario with donated drugs, ARV treatment consumes the entire budget saving up to 2,974 life years annually. A portfolio of prevention interventions does not require the entire budget and results in 135,030 life years saved. Conclusions: Both the cost-effectiveness analysis and the budgetary analysis suggest that HIV prevention interventions should be prioritized if poor countries hope to maximize the scarce resources available for reducing the impact of the AIDS epidemic.

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