Optimal investment in HIV prevention programs: more is not always better.
Optimal investment in HIV prevention programs: more is not always better.
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DOI：
10.1007/s10729-008-9074-7
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发表时间：
2009-03
影响因子：
3.6
通讯作者：
Zaric, Gregory S.
中科院分区：
文献类型：
--
作者：
Brandeau, Margaret L.;Zaric, Gregory S.
本文开发了一个数学/经济学框架来解决以下问题：给定一个特定的人群，一个特定的艾滋病预防计划，以及一个固定的资金，可以投资于该计划，应该投资多少钱？我们认为，在艾滋病毒的充分接触率（定义通过生产函数，描述了足够的接触率的变化作为一个功能的预防计划的支出），和足够的接触率的变化对艾滋病毒的传播（通过流行病模型）的影响，在预防计划的投资的影响。一般来说，每一个避免艾滋病毒感染的成本并不是恒定的，因为投资水平的变化，所以事实上，一些投资的方案是成本效益并不意味着更多的投资方案是成本效益。我们的框架提供了一个正式的手段，以确定如何避免每次感染的成本与支出水平的变化。我们可以如下使用这些信息：当项目避免感染的边际成本递减时（例如，随着流行病的蔓延和预防项目的规模收益递增），最优方案是不花钱或花掉整个预算。当项目避免的每一次感染的边际成本增加时（例如，流行病规模缩小，预防项目的规模收益递减），最好是花掉部分预算，而不是全部预算。应该花费的金额取决于疾病传播的速度和预防计划的生产函数。我们用两个例子来说明我们的想法：针头交换计划和美沙酮维持计划。
This paper develops a mathematical/economic framework to address the following question: Given a particular population, a specific HIV prevention program, and a fixed amount of funds that could be invested in the program, how much money should be invested? We consider the impact of investment in a prevention program on the HIV sufficient contact rate (defined via production functions that describe the change in the sufficient contact rate as a function of expenditure on a prevention program), and the impact of changes in the sufficient contact rate on the spread of HIV (via an epidemic model). In general, the cost per HIV infection averted is not constant as the level of investment changes, so the fact that some investment in a program is cost effective does not mean that more investment in the program is cost effective. Our framework provides a formal means for determining how the cost per infection averted changes with the level of expenditure. We can use this information as follows: When the program has decreasing marginal cost per infection averted (which occurs, for example, with a growing epidemic and a prevention program with increasing returns to scale), it is optimal either to spend nothing on the program or to spend the entire budget. When the program has increasing marginal cost per infection averted (which occurs, for example, with a shrinking epidemic and a prevention program with decreasing returns to scale), it may be optimal to spend some but not all of the budget. The amount that should be spent depends on both the rate of disease spread and the production function for the prevention program. We illustrate our ideas with two examples: that of a needle exchange program, and that of a methadone maintenance program.
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