HIV prevention cost-effectiveness: a systematic review.
HIV prevention cost-effectiveness: a systematic review.
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DOI：
10.1186/1471-2458-9-s1-s5
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发表时间：
2009-11-18
影响因子：
4.5
通讯作者：
Bertozzi SM
中科院分区：
文献类型：
--
作者：
Galárraga O;Colchero MA;Wamai RG;Bertozzi SM
25 年多过去了，公共卫生项目未能充分减少新发艾滋病毒感染人数。每天有超过 7,000 人感染艾滋病毒。缺乏令人信服的成本效益（CE）证据可能是有效计划未能大规模实施的原因之一。本文对 2005 年至 2008 年低收入和中等收入国家艾滋病毒预防干预措施相关的 CE 文献进行了识别、总结和批评。通过多种方法对出版物进行系统识别：电子数据库、国际组织和主要资助/实施机构的互联网搜索以及期刊浏览。纳入标准包括：艾滋病毒预防干预措施、发表年份（2005-2008）、环境（低收入和中等收入国家）以及使用每例艾滋病毒感染避免成本和/或每残疾调整生命年（DALY）或质量调整生命年（QALY）成本的结果进行CE估计（经验或建模）。我们发现了 21 项不同的研究，分析了过去四年（2005-2008 年）发表的艾滋病毒预防干预措施的有效效率。十七项 CE 研究分析了生物医学干预措施；只有少数涉及行为和环境/结构干预。十六项研究重点关注撒哈拉以南非洲地区，只有少数研究关注亚洲、拉丁美洲和东欧。许多艾滋病毒预防干预措施无论从绝对值（使用可避免的每个伤残调整生命年的成本）来看，还是从特定国家的相对角度来看（以每个伤残调整生命年的成本占人均 GDP 的百分比来衡量）都非常具有成本效益。有几种类型的干预措施，CE 研究仍然不可用或不充分，包括监测、禁欲、学校教育、普遍预防措施、积极预防和大多数结构性干预措施。现有的 CE 证据很少，不易进行比较；因此，对于决策来说不是很有用。艾滋病流行已超过 25 年，且投入了数十亿美元，但在成本和有效性方面仍有大量工作要做，以便为艾滋病毒预防规划提供充分信息。
After more than 25 years, public health programs have not been able to sufficiently reduce the number of new HIV infections. Over 7,000 people become infected with HIV every day. Lack of convincing evidence of cost-effectiveness (CE) may be one of the reasons why implementation of effective programs is not occurring at sufficient scale. This paper identifies, summarizes and critiques the CE literature related to HIV-prevention interventions in low- and middle-income countries during 2005-2008. Systematic identification of publications was conducted through several methods: electronic databases, internet search of international organizations and major funding/implementing agencies, and journal browsing. Inclusion criteria included: HIV prevention intervention, year for publication (2005-2008), setting (low- and middle-income countries), and CE estimation (empirical or modeling) using outcomes in terms of cost per HIV infection averted and/or cost per disability-adjusted life year (DALY) or quality-adjusted life year (QALY). We found 21 distinct studies analyzing the CE of HIV-prevention interventions published in the past four years (2005-2008). Seventeen CE studies analyzed biomedical interventions; only a few dealt with behavioral and environmental/structural interventions. Sixteen studies focused on sub-Saharan Africa, and only a handful on Asia, Latin America and Eastern Europe. Many HIV-prevention interventions are very cost effective in absolute terms (using costs per DALY averted), and also in country-specific relative terms (in cost per DALY measured as percentage of GDP per capita). There are several types of interventions for which CE studies are still not available or insufficient, including surveillance, abstinence, school-based education, universal precautions, prevention for positives and most structural interventions. The sparse CE evidence available is not easily comparable; thus, not very useful for decision making. More than 25 years into the AIDS epidemic and billions of dollars of spending later, there is still much work to be done both on costs and effectiveness to adequately inform HIV prevention planning.