Portfolios of Biomedical HIV Interventions in South Africa: A Cost-Effectiveness Analysis

Long, Elisa F; Stavert, Robert

doi:10.1007/s11606-013-2417-1

Cited by 35 publications

(32 citation statements)

References 26 publications

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“…Finally, new interventions or additions to health programmes have typically been evaluated in isolation [11][12][13] and held in comparison to an estimate of the cost-effectiveness of interventions already funded, an approach that ignores the relative costs and impacts of alternative options. Exceptions in Africa include a national-level cost-effectiveness analysis of prevention portfolios 14 and an exploration of combination prevention in a hyperendemic setting. 15 The Optimal model 16 has informed national priority setting and programme planning in several African countries, though to date countries tend not to account explicitly for subnational heterogeneity in choosing intervention packages for population groups.…”

Section: Introductionmentioning

confidence: 99%

Optimum resource allocation to reduce HIV incidence across sub-Saharan Africa: a mathematical modelling study

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Optimum resource allocation to reduce HIV incidence across sub-Saharan Africa: a mathematical modelling study

et al. 2016

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“…A number of studies of concurrent prevention and treatment programs have observed this phenomenon. 19, 25, 26, 31, 37 …”

Section: Model Formulationmentioning

confidence: 99%

HIV Treatment and Prevention

Juusola

Brandeau

2015

Med Decis Making

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Objective. To create a simple model to help public health decision makers determine how to best invest limited resources in HIV treatment scale-up and prevention. Method. A linear model was developed for determining the optimal mix of investment in HIV treatment and prevention, given a fixed budget. The model incorporates estimates of secondary health benefits accruing from HIV treatment and prevention and allows for diseconomies of scale in program costs and subadditive benefits from concurrent program implementation. Data sources were published literature. The target population was individuals infected with HIV or at risk of acquiring it. Illustrative examples of interventions include preexposure prophylaxis (PrEP), community-based education (CBE), and antiretroviral therapy (ART) for men who have sex with men (MSM) in the US. Outcome measures were incremental cost, quality-adjusted life-years gained, and HIV infections averted. Results. Base case analysis indicated that it is optimal to invest in ART before PrEP and to invest in CBE before scaling up ART. Diseconomies of scale reduced the optimal investment level. Subadditivity of benefits did not affect the optimal allocation for relatively low implementation levels. The sensitivity analysis indicated that investment in ART before PrEP was optimal in all scenarios tested. Investment in ART before CBE became optimal when CBE reduced risky behavior by 4% or less. Limitations of the study are that dynamic effects are approximated with a static model. Conclusions. Our model provides a simple yet accurate means of determining optimal investment in HIV prevention and treatment. For MSM in the US, HIV control funds should be prioritized on inexpensive, effective programs like CBE, then on ART scale-up, with only minimal investment in PrEP.

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“…Van Howe's previous calculations that condoms would be cheaper,61 were shown to be erroneous 62. Recent analyses have found pre-exposure prophylaxis to be less cost effective than male circumcision for HIV prevention 63. Circumcision is more cost effective than antiretroviral treatment 64…”

Section: Are There ‘Logical Leaps’ In the Aap's Statement?mentioning

confidence: 99%

Veracity and rhetoric in paediatric medicine: a critique of Svoboda and Van Howe's response to the AAP policy on infant male circumcision

et al. 2013

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In a recent issue of the Journal of Medical Ethics,Svoboda and Van Howe commented on the 2012 changein the American Academy of Pediatrics (AAP) policy on newborn male circumcision, in which the AAP stated that benefits of the procedure outweigh the risks. Svoboda and Van Howe disagree with the AAP conclusions. We show here that their arguments against male circumcision are based on a poor understanding of epidemiology,erroneous interpretation of the evidence, selective citation of the literature, statistical manipulation of data, and circular reasoning. In reality, the scientific evidence indicates that male circumcision, especially when performed in the newborn period, is an ethically and medically sound low-risk preventive health procedure conferring a lifetime of benefits to health and well-being.Policies in support of parent-approved elective newborn circumcision should be embraced by the medical,scientific and wider communities.

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Portfolios of Biomedical HIV Interventions in South Africa: A Cost-Effectiveness Analysis

Cited by 35 publications

References 26 publications

Optimum resource allocation to reduce HIV incidence across sub-Saharan Africa: a mathematical modelling study

Optimum resource allocation to reduce HIV incidence across sub-Saharan Africa: a mathematical modelling study

HIV Treatment and Prevention

Veracity and rhetoric in paediatric medicine: a critique of Svoboda and Van Howe's response to the AAP policy on infant male circumcision

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