Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence
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 comprehensivel...
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| Veröffentlicht in: | The Lancet (British edition) 2002-05, Vol.359 (9318), p.1635-1642 |
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| description | 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.
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.
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 $75 per DALY gained. Other interventions, such as formula feeding for infants, home care programmes, and antiretroviral therapy for adults, cost several thousand dollars per infection prevented, or several hundreds of dollars per DALY gained
A strong economic case exists for prioritisation of preventive interventions and tuberculosis treatment. Where potentially exclusive alternatives exist, cost-effectiveness analysis points to an intervention that offers the best value for money. Cost-effectiveness analysis is an essential component of informed debate about priority setting for HIV/AIDS. |
| doi_str_mv | 10.1016/S0140-6736(02)08595-1 |
| format | Article |
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We undertook a systematic review using databases and consultations with experts. We identified over 60 reports that measured both the cost and effectiveness of HIV/AIDS interventions in Africa. 24 studies met our inclusion criteria and were used to calculate standardised estimates of the cost (US$ for year 2000) per HIV infection prevented and per disability-adjusted life-year (DALY) gained for 31 interventions.
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
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.</description><identifier>ISSN: 0140-6736</identifier><identifier>ISSN: 0099-5355</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(02)08595-1</identifier><identifier>PMID: 12020523</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Acquired immune deficiency syndrome ; Acquired Immunodeficiency Syndrome - prevention & control ; Africa ; AIDS ; AIDS-Related Opportunistic Infections - economics ; AIDS-Related Opportunistic Infections - prevention & control ; Anti-HIV Agents - economics ; Anti-HIV Agents - therapeutic use ; Antiretroviral agents ; Biological and medical sciences ; Cost estimates ; Cost-Benefit Analysis - statistics & numerical data ; Disease transmission ; Female ; Health Priorities ; HIV ; HIV Infections - drug therapy ; HIV Infections - economics ; HIV Infections - prevention & control ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Infectious diseases ; Life expectancy ; Male ; Medical sciences ; Prevention ; Public health ; Quality-Adjusted Life Years ; Sensitivity analysis ; Sexually transmitted diseases ; Side effects ; STD ; Systematic review ; Tuberculosis ; Tuberculosis - economics ; Tuberculosis - prevention & control ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids</subject><ispartof>The Lancet (British edition), 2002-05, Vol.359 (9318), p.1635-1642</ispartof><rights>2002 Elsevier Ltd</rights><rights>2002 INIST-CNRS</rights><rights>Copyright Lancet Ltd. May 11, 2002</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c533t-188df2de1495e60d972c342870359248766410c2570e7108ecc565b5ccb62a1d3</citedby><cites>FETCH-LOGICAL-c533t-188df2de1495e60d972c342870359248766410c2570e7108ecc565b5ccb62a1d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/199003587?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13642811$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12020523$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Creese, Andrew</creatorcontrib><creatorcontrib>Floyd, Katherine</creatorcontrib><creatorcontrib>Alban, Anita</creatorcontrib><creatorcontrib>Guinness, Lorna</creatorcontrib><title>Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>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.
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.
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
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.</description><subject>Acquired immune deficiency syndrome</subject><subject>Acquired Immunodeficiency Syndrome - prevention & control</subject><subject>Africa</subject><subject>AIDS</subject><subject>AIDS-Related Opportunistic Infections - economics</subject><subject>AIDS-Related Opportunistic Infections - prevention & control</subject><subject>Anti-HIV Agents - economics</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Biological and medical sciences</subject><subject>Cost estimates</subject><subject>Cost-Benefit Analysis - statistics & numerical data</subject><subject>Disease transmission</subject><subject>Female</subject><subject>Health Priorities</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - economics</subject><subject>HIV Infections - prevention & control</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Life expectancy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Prevention</subject><subject>Public health</subject><subject>Quality-Adjusted Life Years</subject><subject>Sensitivity analysis</subject><subject>Sexually transmitted diseases</subject><subject>Side effects</subject><subject>STD</subject><subject>Systematic review</subject><subject>Tuberculosis</subject><subject>Tuberculosis - economics</subject><subject>Tuberculosis - prevention & control</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><issn>0140-6736</issn><issn>0099-5355</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkV1rFDEUhoModl39Ccog-HUx9pxMvsYbWdaPLhS8qIrgRchmzmDK7kybZCv992a6iwUv7FU44XlfcvIw9hThLQKq4zNAAbXSjXoN_A0Y2coa77EZCi1qKfSP-2z2Fzlij1I6BwChQD5kR8iBg-TNjP1cjinX1Pfkc7iigVKqxr46WX0_Xqw-nFVhyBTLfQ7jkMpULfoYvHtXuSpdp0xbl4OvIl0F-j0F8y-qytDR4Okxe9C7TaInh3POvn36-HV5Up9--bxaLk5rL5sm12hM1_OOULSSFHSt5r4R3GhoZMuF0UoJBM-lBtIIhryXSq6l92vFHXbNnL3a917E8XJHKdttSJ42GzfQuEtWl7yUvPTN2cv_k6hBgTJ3gmgkl6LRBXz-D3g-7uJQ1rXYtlBWMBMk95CPY0qRensRw9bFa4tgJ5v2xqadVFng9samxZJ7dijfrbfU3aYO-grw4gC45N2mj27wId1yjSr_iFPR-z1HRUNRFW3yYVLUhVjE224MdzzlD3bPuHM</recordid><startdate>20020511</startdate><enddate>20020511</enddate><creator>Creese, Andrew</creator><creator>Floyd, Katherine</creator><creator>Alban, Anita</creator><creator>Guinness, Lorna</creator><general>Elsevier Ltd</general><general>Lancet</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20020511</creationdate><title>Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence</title><author>Creese, Andrew ; Floyd, Katherine ; Alban, Anita ; Guinness, Lorna</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c533t-188df2de1495e60d972c342870359248766410c2570e7108ecc565b5ccb62a1d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Acquired Immunodeficiency Syndrome - prevention & control</topic><topic>Africa</topic><topic>AIDS</topic><topic>AIDS-Related Opportunistic Infections - economics</topic><topic>AIDS-Related Opportunistic Infections - prevention & control</topic><topic>Anti-HIV Agents - economics</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Antiretroviral agents</topic><topic>Biological and medical sciences</topic><topic>Cost estimates</topic><topic>Cost-Benefit Analysis - statistics & numerical data</topic><topic>Disease transmission</topic><topic>Female</topic><topic>Health Priorities</topic><topic>HIV</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - economics</topic><topic>HIV Infections - prevention & control</topic><topic>Human immunodeficiency virus</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Life expectancy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Prevention</topic><topic>Public health</topic><topic>Quality-Adjusted Life Years</topic><topic>Sensitivity analysis</topic><topic>Sexually transmitted diseases</topic><topic>Side effects</topic><topic>STD</topic><topic>Systematic review</topic><topic>Tuberculosis</topic><topic>Tuberculosis - economics</topic><topic>Tuberculosis - prevention & control</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Creese, Andrew</creatorcontrib><creatorcontrib>Floyd, Katherine</creatorcontrib><creatorcontrib>Alban, Anita</creatorcontrib><creatorcontrib>Guinness, Lorna</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>News PRO</collection><collection>Pharma and Biotech Premium PRO</collection><collection>Global News & ABI/Inform Professional</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Lancet Titles</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Newsstand Professional</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Creese, Andrew</au><au>Floyd, Katherine</au><au>Alban, Anita</au><au>Guinness, Lorna</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2002-05-11</date><risdate>2002</risdate><volume>359</volume><issue>9318</issue><spage>1635</spage><epage>1642</epage><pages>1635-1642</pages><issn>0140-6736</issn><issn>0099-5355</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>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.
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.
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
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.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>12020523</pmid><doi>10.1016/S0140-6736(02)08595-1</doi><tpages>8</tpages></addata></record> |
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| subjects | Acquired immune deficiency syndrome Acquired Immunodeficiency Syndrome - prevention & control Africa AIDS AIDS-Related Opportunistic Infections - economics AIDS-Related Opportunistic Infections - prevention & control Anti-HIV Agents - economics Anti-HIV Agents - therapeutic use Antiretroviral agents Biological and medical sciences Cost estimates Cost-Benefit Analysis - statistics & numerical data Disease transmission Female Health Priorities HIV HIV Infections - drug therapy HIV Infections - economics HIV Infections - prevention & control Human immunodeficiency virus Human viral diseases Humans Infectious diseases Life expectancy Male Medical sciences Prevention Public health Quality-Adjusted Life Years Sensitivity analysis Sexually transmitted diseases Side effects STD Systematic review Tuberculosis Tuberculosis - economics Tuberculosis - prevention & control Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids |
| title | Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence |
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