Cost-Effectiveness Assessments of Prevention, Treatment Interventions Needed for Appropriate Response to Epidemic in Africa, Analysis SaysCost-effectiveness evaluations of HIV/AIDS interventions are an "essential component of informed debate about priority setting for HIV/AIDS" responses in Africa, according to a systematic review appearing in the May 11 issue of the Lancet. The researchers, led by Andrew Creese of the World Health Organization, identified more than 60 studies that measured the cost and effectiveness of different HIV/AIDS interventions in Africa. They found 24 studies that met their inclusion criteria and used those studies to calculate standardized estimates of the cost per HIV infection prevented and per disability-adjusted life year (DALY) gained for 31 different interventions.
Cost Per HIV Infection Prevented
The researchers found that the cost per HIV infection prevented varied widely. Costs for condom distribution ranged from $11 to more than $2,000, while blood safety measures ranged from under $20 to about $1,000. The cost per HIV case prevented of diagnosing and treating other STDs averaged a little more than $270, and the cost of voluntary testing and counseling averaged between $400 and $500. The costs of interventions to prevent vertical HIV transmission varied the most, with prices for a single dose of nevirapine ranging from $20 to $341 and breastfeeding and formula interventions ranging in cost from $4,000 to more than $20,000 per HIV infection prevented.
Cost Per DALY Gained
Cost per DALY gained by interventions also varied, although not as widely. The cost for combined STD treatment and condom distribution was about $1 compared to "well over $1,000" for highly active antiretroviral therapy for adults. Single-dose nevirapine and blood safety measures cost about $10 per DALY gained, while the cost of tuberculosis treatment ranged from $10 per DALY gained to $68 per DALY gained if in-patient care was involved. Home-based care also ranged from about $100 to $1,000 per DALY gained.
The authors note that the study has several limitations, most notably a lack of numerous studies for comparison. For five interventions, only one study was found, while no intervention was analyzed in more than four studies. In addition, in no one country were all interventions studied. "[V]alue for money is important, especially in African countries, where resources are particularly scarce and needs are so great," the researchers state, noting that "[s]ubstantial new resources" are becoming available through the Global Fund to Fight AIDS, Tuberculosis and Malaria and other sources. "Existing cost-effectiveness data are few, and much more high-quality research is needed for detailed planning and programming," they note, concluding, "Yet even the available data make it clear that a spending program for HIV/AIDS relief in Africa that neglects to bring cost-effectiveness evidence into the consultation process risks unnecessary sacrifice of hundreds of thousands of prevention opportunities, treatment opportunities and lives" (Creese et al., Lancet, 5/11).