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Effectiveness and cost-effectiveness of strategies to expand antiretroviral therapy in St. Petersburg, Russia.

https://arctichealth.org/en/permalink/ahliterature166730
Source
AIDS. 2006 Nov 14;20(17):2207-15
Publication Type
Article
Date
Nov-14-2006
Author
Elisa F Long
Margaret L Brandeau
Cristina M Galvin
Tatyana Vinichenko
Swati P Tole
Adam Schwartz
Gillian D Sanders
Douglas K Owens
Author Affiliation
Department of Management Science and Engineering, Stanford University, Stanford, CA 94305, USA. elisa46@stanford.edu
Source
AIDS. 2006 Nov 14;20(17):2207-15
Date
Nov-14-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antiretroviral Therapy, Highly Active - economics
Cost-Benefit Analysis
HIV Infections - drug therapy - economics - transmission
Humans
Middle Aged
Prevalence
Quality-Adjusted Life Years
Russia - epidemiology
Substance Abuse, Intravenous - drug therapy - economics
Abstract
To assess the effectiveness and cost-effectiveness of treating HIV-infected injection drug users (IDUs) and non-IDUs in Russia with highly active antiretroviral therapy HAART.
A dynamic HIV epidemic model was developed for a population of IDUs and non-IDUs. The location for the study was St. Petersburg, Russia. The adult population aged 15 to 49 years was subdivided on the basis of injection drug use and HIV status. HIV treatment targeted to IDUs and non-IDUs, and untargeted treatment interventions were considered. Health care costs and quality-adjusted life years (QALYs) experienced in the population were measured, and HIV prevalence, HIV infections averted, and incremental cost-effectiveness ratios of different HAART strategies were calculated.
With no incremental HAART programs, HIV prevalence reached 64% among IDUs and 1.7% among non-IDUs after 20 years. If treatment were targeted to IDUs, over 40 000 infections would be prevented (75% among non-IDUs), adding 650 000 QALYs at a cost of USD 1501 per QALY gained. If treatment were targeted to non-IDUs, fewer than 10 000 infections would be prevented, adding 400 000 QALYs at a cost of USD 2572 per QALY gained. Untargeted strategies prevented the most infections, adding 950 000 QALYs at a cost of USD 1827 per QALY gained. Our results were sensitive to HIV transmission parameters.
Expanded use of antiretroviral therapy in St. Petersburg, Russia would generate enormous population-wide health benefits and be economically efficient. Exclusively treating non-IDUs provided the least health benefit, and was the least economically efficient. Our findings highlight the urgency of initiating HAART for both IDUs and non-IDUs in Russia.
PubMed ID
17086061 View in PubMed
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Improved allocation of HIV prevention resources: using information about prevention program production functions.

https://arctichealth.org/en/permalink/ahliterature175627
Source
Health Care Manag Sci. 2005 Feb;8(1):19-28
Publication Type
Article
Date
Feb-2005
Author
Margaret L Brandeau
Gregory S Zaric
Vanda de Angelis
Author Affiliation
Department of Management Science and Engineering, Stanford University, Stanford, CA 94305, USA.
Source
Health Care Manag Sci. 2005 Feb;8(1):19-28
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
HIV Infections - epidemiology - prevention & control
Humans
Preventive Health Services - economics - organization & administration - standards
Resource Allocation
Abstract
To allocate HIV prevention resources effectively, it is important to have information about the effectiveness of alternative prevention programs as a function of expenditure. We refer to this relationship as the "production function" for a prevention program. Few studies of HIV prevention programs have reported this relationship. This paper demonstrates the value of such information. We present a simple model for allocating HIV prevention resources, and apply the model to an illustrative HIV prevention resource allocation problem. We show that, without sufficient information about prevention program production functions, suboptimal decisions may be made. We show that epidemiologic data, such as estimates of HIV prevalence or incidence, may not provide enough information to support optimal allocation of HIV prevention resources. Our results suggest that good allocations can be obtained based on fairly basic information about prevention program production functions: an estimate of fixed cost plus a single estimate of cost and resulting risk reduction. We find that knowledge of production functions is most important when fixed cost is high and/or when the budget is a significantly constraining factor. We suggest that, at the minimum, future data collection on prevention program effectiveness should include fixed and variable cost estimates for the intervention when implemented at a "typical" level, along with a detailed description of the intervention and detailed description of costs by category.
PubMed ID
15782509 View in PubMed
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