Designing an Optimal HIV Programme for South Africa
2017
This 2017 study compares the traditional and a novel method of comparing cost-effectiveness interventions in the context of HIV in South Africa, using a modeling approach. The authors argue that the assumptions of a) independence of interventions, and b) linear scale-up effects do not hold because South Africa has a large domestically funded HIV program with highly saturated coverage levels. The authors therefore aim to better allocate resources for HIV interventions in South Africa when the aforementioned two assumptions do not hold, using an “optimization method”. The analysis allowed the simultaneous consideration of a large number of HIV interventions and their potentially diminishing marginal returns to scale. The results show that the rank order of interventions did not differ substantially between the two methods (condom availability and male medical circumcision were found to be most cost-effective in both methods, followed by anti-retroviral therapy). However, interventions were less cost-effective throughout when evaluated under the optimization method with ICERs 437% higher under the new method. This indicates substantial diminishing marginal returns. Accounting for interaction and non-linear scale-up effects provides more realistic estimates in highly saturated real-world settings.
Designing an Optimal HIV Programme for South Africa
Source:
Chiu C, Johnson LF, Jamieson L et al. Designing an Optimal HIV Programme for South Africa: Does the Optimal Package Change when Diminishing Returns are Considered? BMC Public Health 2017; 17:43. https://doi.org/10.1186/s12889-017-4023-3