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The effectiveness of cost-effectiveness of analysis: Stories of two practitioners. Elliot Marseille, MPP, DrPH Institute for Health Policy Studies University of California, San Francisco February 15 , 2007 DCEA. HIV in the Developing World. 38.6 million HIV+ worldwide in 2005 (UNAIDS,2006)
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Elliot Marseille, MPP, DrPHInstitute for Health Policy StudiesUniversity of California, San Francisco
February 15, 2007
Number of Cases
Quarter-Year of Diagnosis
Source: CDC 2000.
Elliot Marseille, Dr.P.H., M.P.P - Health Strategies International
James G. Kahn, M.D., M.P.H. - University of California, San Francisco
Francis Mmiro, MBChB, FRCOG - Makerere University, Kampala
Laura Guay, M.D. - Johns Hopkins University
Philippa Musoke, MBChB - Makerere University, Kampala
Mary Glenn Fowler, M.D. Centers for Disease Control and Prevention
J. Brooks Jackson, M.D. - Johns Hopkins University
Thus, Tororo study at $615 per DALY averted incremental to CTX = relatively favorable CE.
Prevention components account for ~35%
of ART scale-up - # 1
Community ARV resistance
Effect on CE: Negative but possibly small
Adherence high in developing countries (very high in Tororo)
of ART scale-up - # 2
Shift of resources away from other health activities (?)
Effect on CE: Negative and potentially important
“… in Africa many grass roots organizations and non-governmental organizations for people living with HIV, which were traditionally involved in community mobilization and prevention, have shifted their focus to treatment support activities.”
Van Damme, W. et al. AIDS 2006 The real challenges for scaling up ART in sub-Saharan Africa. Editorial Review.
Thailand reduced spending on prevention by 75% in 1997 – 2003. Prevention accounted for 8% of all HIV spending in 2003.
(UNDP, Thailand’s response to HIV/AIDS,2004)
of ART scale-up – # 3
Effect on CE: Probably net positive
Community ‘risk compensation’
Effect on CE: Probably net negative
Political process determines policy not economic appraisal.
But analysis can help determine what is on the political agenda.