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HIV treatment as prevention: issues in economic evaluation
Till Bärnighausen1, Joshua A Salomon, Nalinee Sangrujee
1Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America. tbaernig@hsph.harvard.edu
Plos Medicine
|July 18, 2012
Summary
Economic evaluations of HIV treatment as prevention (TasP) require specific cost functions. Current antiretroviral therapy (ART) program costs and outcomes are not generalizable to TasP due to unique program components and effects.
Area of Science:
- Public Health
- Health Economics
- HIV/AIDS Research
Background:
- Economic evaluations of antiretroviral therapy (ART) are crucial for understanding treatment as prevention (TasP) programs.
- Existing cost functions for ART may not adequately capture the complexities of TasP.
Purpose of the Study:
- To argue for the necessity of tailored cost functions in economic evaluations of TasP.
- To explain why cost and outcome data from current ART programs are not generalizable to TasP.
Main Methods:
- Literature review and critical analysis of economic evaluation methodologies for HIV interventions.
- Discussion of the unique components and expected outcomes of TasP programs compared to standard ART.
Main Results:
- Less detailed cost functions may suffice for specific TasP evaluation purposes and perspectives.
- TasP programs necessitate new components (e.g., widespread testing, immediate ART uptake) with associated costs not found in current ART estimates.
- Early ART initiation in TasP alters patient disease courses, treatment experiences, quality of life, and economic outcomes.
- The preventive effects of TasP are likely to change the HIV-infected population's characteristics over time, impacting future costs and outcomes.
Conclusions:
- Economic evaluations of TasP require distinct cost functions that account for program-specific factors.
- Generalizing cost and outcome data from current ART programs to TasP programs is methodologically unsound.
- Future research should focus on developing and applying appropriate economic evaluation frameworks for TasP.
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