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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 Unpublished data. 2006