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 Unpublished data. 2006