8th International Conference on psychosocial and economic aspects of HIV infection
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 , ,00010,000100,000 Annual clients receiving VCT MexicoUgandaRussiaIndiaSouth Africa US$ Average Unit Costs Source: Preliminary analysis of PANCEA data. Unpublished data. 2006