Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence
Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence
复制标题
DOI：
10.1016/s0140-6736(02)08595-1
复制
发表时间：
2002-05-11
期刊：
影响因子：
168.9
通讯作者：
Guinness, L
中科院分区：
文献类型：
--
作者：
Creese, A;Floyd, K;Guinness, L
关于非洲艾滋病毒/艾滋病干预措施成本效益的背景证据并不完整。然而，成本效益是高度相关的。非洲各国政府面临着在预防、治疗和护理之间取得适当平衡的艰难选择，所有这些都是全面应对该流行病所必需的。药品价格的降低提高了治疗的优先顺序，尽管治疗机会受到限制。我们评估了现有的成本效益数据及其对非洲防治艾滋病毒/艾滋病的物有所值战略的影响。方法我们利用数据库和专家咨询进行系统审查。我们确定了60多份报告，这些报告衡量了非洲艾滋病毒/艾滋病干预措施的成本和效果。有24项研究符合我们的纳入标准，用于计算31项干预措施的每项艾滋病毒感染预防费用和每项残疾调整生命年(DALY)的标准化估计费用(2000年为美元)。不同干预措施的成本效益差异很大。通过选择性的血液安全措施，以及有针对性地分发避孕套和性传播疾病，可以用11美元预防一例艾滋病毒/艾滋病，用1美元就可以预防一例DALY。单剂奈韦拉平和短程齐多夫定用于预防母婴传播、自愿咨询和检测以及结核病治疗，每增加一次DALY的费用不到75美元。其他干预措施，如婴儿配方奶喂养、家庭护理计划和成人抗逆转录病毒治疗，每预防一次感染需要花费数千美元，或每获得数百美元的DALY。在可能存在排他性替代方案的地方，成本效益分析指出，一种提供最佳性价比的干预措施。成本效益分析是关于确定艾滋病毒/艾滋病优先事项的知情辩论的重要组成部分。
Background Evidence for cost-effectiveness of interventions for HIV/AIDS in Africa is fragmentary. Cost-effectiveness is, however, highly relevant. African governments face difficult choices in striking the right balance between prevention, treatment, and care, all of which are necessary to deal comprehensively with the epidemic. Reductions in drug prices have raised the priority of treatment, though treatment access is restricted. We assessed the existing cost-effectiveness data and its implications for value-for-money strategies to combat HIV/AIDS in Africa.Methods We undertook a systematic review using databases and consultations with experts. We identified over 60 reports that measured both the cost and effectiveness of HIV/AIDS interventions in Africa. 24 studies met our inclusion criteria and were used to calculate standardised estimates of the cost (US$ for year 2000) per HIV infection prevented and per disability-adjusted life-year (DALY) gained for 31 interventions.Findings Cost-effectiveness varied greatly between interventions. A case of HIV/AIDS can be prevented for $11, and a DALY gained for $1, by selective blood safety measures, and by targeted condom distribution with treatment of sexually transmitted diseases. Single-dose nevirapine and short-course zidovudine for prevention of mother-to-child transmission, voluntary counselling and testing, and tuberculosis treatment, cost under $75 per DALY gained. Other interventions, such as formula feeding for infants, home care programmes, and antiretroviral therapy for adults, cost several thousand dollars per infection prevented, or several hundreds of dollars per DALY gained.Interpretation A strong economic case exists for prioritisation of preventive interventions and tuberculosis treatment. Where potentially exclusive alternatives exist, cost-effectiveness analysis points to an intervention that offers the best value for money. Cost-effectiveness analysis is an essential component of informed debate about priority setting for HIV/AIDS.