Simple preventive interventions may be cost-effective for HIV in Africa

Pinkerton, Steven D PhD

Center for AIDS Intervention Research; Medical College of Wisconsin, USA

Abstracted from:Creese A, Floyd K, Alban A, Guinness L. Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence. Lancet 2002; 359: 1635-1643 .

Source of funding: No specific funding was provided for this work. It was completed as part of the professional responsibilities of the authors.

Correspondence to: A Creese, Essential Drugs and Medicines Policy Department, WHO, Geneva, Switzerland. Email: [email protected]

Abstract prepared by Bazian Ltd, London

Evidence-based Healthcare 7(1):p 3-5, March 2003.

BACKGROUND

About 20% of deaths and disability-adjusted life years lost in Africa are related to HIV/AIDS. African governments must balance prevention, treatment and palliative care when funding interventions to reduce HIV. Evidence about the cost-effectiveness of different interventions is fragmented.

OBJECTIVE

To assess the cost-effectiveness of strategies to combat HIV/AIDS in Africa.

METHOD

Systematic review.

SEARCH STRATEGY

MEDLINE, Popline and EconLit were searched for studies published between 1984 and 2000. Bibliographies were searched for additional studies. Abstracts from international conferences were searched, but were excluded due to insufficient detail. Experts were consulted for unpublished studies.

INCLUSION/EXCLUSION CRITERIA

Fifty-seven studies and nine reviews were identified that measured both costs and effectiveness of HIV/AIDS interventions in Africa. Exclusion criteria were outdated regimens; incomplete data for major costs; non-standard methods for estimating costs and outcomes; data based on estimates, or drug prices altered substantially since trial. Twenty-four articles with 31 interventions were included.

DATA EXTRACTION

Reviewers calculated standardised estimates of costs and effects.

OUTCOMES

Cost per HIV infection prevented and per disability-adjusted life year gained ($US for the year 2000).

MAIN RESULTS

The cost-effectiveness of different interventions varied (Table 1). Selective blood safety measures and targeted condom distribution were the most cost-effective strategies. Antiretroviral therapy for adults, preventative tuberculosis therapy and home care were the least cost-effective.

Table 1 Cost-effectiveness of strategies to reduce HIV/AIDS in Africa
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AUTHORS' CONCLUSIONS

Cost-effectiveness analyses can help prioritise spending on HIV/AIDS prevention and treatment. Simple preventive interventions and short course tuberculosis treatment could be prioritised in Africa.