Cost-effectiveness assessments important for HIV response in Africa

May 09, 2002

A systematic review in this week's issue of THE LANCET highlights the importance of cost-effectiveness evaluation to identify realistic intervention programmes to tackle HIV/AIDS in Africa.

HIV/AIDS accounts for around 20% of all deaths in Africa. The cost-effectiveness of interventions is important as African governments face difficult choices in striking the right balance between prevention, treatment, and care, all of which are necessary to deal with the HIV/AIDS epidemic. Andrew Creese from WHO, Geneva, Switzerland, and colleagues assessed existing data and their implications for value-for-money strategies to combat HIV/AIDS in Africa.

The investigators identified over 60 reports that measured cost and effectiveness of HIV/AIDS interventions. 24 studies were used to calculate standardised estimates of cost (US$) per HIV infection prevented and cost per disability-adjusted life-year (DALY) gained for 31 interventions.

Cost-effectiveness varied greatly between interventions. A case of HIV/AIDS could be prevented for $11, and a DALY gained for $1, by selective blood safety measures, and by targeted condom distribution with treatment of sexually transmitted diseases. Single-dose nevirapine and short-course zidovudine for prevention of mother-to-child transmission, voluntary counselling and testing, and tuberculosis treatment cost under $75 per DALY gained. Other interventions (eg. formula feeding for infants, home care programmes, and antiretroviral therapy for adults) cost several thousand dollars per infection prevented, or several hundreds of dollars per DALY gained.

Andrew Creese comments: "Allocation of new funds for HIV/AIDS requires more than rankings of cost-effectiveness. Nevertheless, value for money is important, especially in African countries, where resources are particularly scarce and needs are so great. Existing cost-effectiveness data are few, and much more high quality research is needed for detailed planning and programming. Yet even the available data make it clear that a spending programme 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."

A research letter (p 1667) in this week's issue of THE LANCET describes the potential of a low-cost drug combination for people with HIV-1 infection. Nicholas Paton and colleagues from Tan Tock Seng Hospital, Singapore, gave 22 individuals with HIV-1 a combination of the drugs hydroxychloroquine, hydroxycarbamide, and didanosine taken twice daily for just under a year. The treatment produced a sustained reduction in viral load and the CD4 cell count was maintained. The investigators conclude that this new combination of drugs could be suitable for countries that have restricted resources.
Contact: Mr Andrew Creese, Essential Drugs and Medicines Policy Department, WHO, 1211 Geneva 27, Switzerland; T) +41 22 791 2570; F) +41 22 791 4167; E)

Dr Nicholas I Paton, Department of Infectious Diseases, Communicable Disease Centre, Tan Tock Seng Hospital, Moulmein Road, 308433, Singapore; T) +65 6357 7924/5; F) +65 6252 4056; E)


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