8th International Conference on psychosocial and economic aspects of HIV infection www.aidsimpact.net.

Présentation au sujet: "8th International Conference on psychosocial and economic aspects of HIV infection www.aidsimpact.net."— Transcription de la présentation:

1 8th International Conference on psychosocial and economic aspects of HIV infection www.aidsimpact.net

2 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

3 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 ?   (+)(-)

4 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

5 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

6 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

7 Scale and Average Unit Cost of VCT programs in 5 countries 1 10 100 1,000 1101001,00010,000100,000 Annual clients receiving VCT MexicoUgandaRussiaIndiaSouth Africa US$ Average Unit Costs Source: Preliminary analysis of PANCEA data. Unpublished data. 2006