Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries

doi:10.1136/bmj.38643.368692.68

BMJ 2005;331:1431-1437 (17 December), doi:10.1136/bmj.38643.368692.68 (published 10 November 2005)

Paper

Achieving the millennium development goals for health

Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries

This article is part of a series examining the cost effectivenessof strategies to achieve the millennium development goals forhealth

Daniel R Hogan, researcher¹, Rob Baltussen, health economist², Chika Hayashi, monitoring and evaluation officer³, Jeremy A Lauer, economist⁴, Joshua A Salomon, assistant professor of international health⁵

¹ Harvard Center for Population and Development Studies, Harvard School of Public Health, Cambridge, MA, USA, ² Institute for Medical Technology Assessment, Erasmus Medical Centre, Rotterdam, Netherlands, ³ Strategic Information and Research, Department of HIV/AIDS, World Health Organization, Geneva, Switzerland, ⁴ Costs, Effectiveness, Expenditure and Priority Setting Team, Health Systems Financing Department, World Health Organization, Geneva, ⁵ Department of Population and International Health, Harvard School of Public Health, Boston, MA, USA

Correspondence to: J A Salomon, Harvard School of Public Health, Harvard University Initiative for Global Health, 104 Mount Auburn Street, Third Floor, Cambridge, MA 02138, USA jsalomon{at}hsph.harvard.edu

Objective To assess the costs and health effects of a rangeof interventions for preventing the spread of HIV and for treatingpeople with HIV/AIDS in the context of the millennium developmentgoal for combating HIV/AIDS.

Design Cost effectiveness analysis based on an epidemiologicalmodel.

Setting Analyses undertaken for two regions classified usingthe WHO epidemiological grouping—Afr-E, countries in sub-SaharanAfrica with very high adult and high child mortality, and Sear-D,countries in South East Asia with high adult and high childmortality.

Data sources Biological and behavioural parameters from clinicaland observational studies and population based surveys. Interventioneffects and resource inputs based on published reports, expertopinion, and the WHO-CHOICE database.

Main outcome measures Costs per disability adjusted life year(DALY) averted in 2000 international dollars ($Int).

Results In both regions interventions focused on mass media,education and treatment of sexually transmitted infections forfemale sex workers, and treatment of sexually transmitted infectionsin the general population cost < $Int150 per DALY averted.Voluntary counselling and testing costs < $Int350 per DALYaverted in both regions, while prevention of mother to childtransmission costs < $Int50 per DALY averted in Afr-E butaround $Int850 per DALY in Sear-D. School based education strategiesand various antiretroviral treatment strategies cost between$Int500 and $Int5000 per DALY averted.

Conclusions Reducing HIV transmission could be done most efficientlythrough mass media campaigns, interventions for sex workersand treatment of sexually transmitted infections where resourcesare most scarce. However, prevention of mother to child transmission,voluntary counselling and testing, and school based educationwould yield further health gains at higher budget levels andwould be regarded as cost effective or highly cost effectivebased on standard international benchmarks. Antiretroviral therapyis at least as cost effective in improving population healthas some of these interventions.

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