ArticlesCost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence
Introduction
HIV/AIDS accounts for about 20% of all deaths and disability-adjusted life-years (DALYs) lost in Africa, which makes it the biggest single component of the continent's disease burden.1 The epidemic has reduced life expectancy in the worst affected countries by more than 10 years, and its social and economic consequences have been devastating2
Substantial new resources are becoming available for prevention, care, and support. The European Commission is committed to a major increase in spending on the diseases of poverty, including HIV/AIDS3. A global fund to fight AIDS, tuberculosis, and malaria became operational in January, 2002; so far pledges are in the region of US$2 billion (www.globalfundatm.org).
To ensure that any new resources have the maximum possible effect on the epidemic, cost-effectiveness should be considered in the design of strategies for prevention, care, and support. As Kahn and Marseille have pointed out4, the scale of the HIV/AIDS epidemic combined with scarcity of resources makes cost-effectiveness especially important in developing countries. Up to now, however, cost-effectiveness has been well documented only for industrialised countries5, 6. For low-income and middle-income countries, we could identify only one detailed review, which addressed interventions to reduce mother-to-child transmission7. For Africa, investigators focused on individual HIV/AIDS-related interventions. We could not identify any published report that brought together the evidence base in a standardised way that allowed comparison among interventions.
We report a critical assessment of studies of the cost-effectiveness of HIV/AIDS interventions in Africa, and present their results in a standard form.
Section snippets
Review of published work
We searched Medline, Popline, and EconLit databases for 1984–2000 using the key words HIV, AIDS, and HIV/AIDS in combination with each of the terms: costs; cost-effectiveness; cost-benefit analysis; economics; and Africa. Citations and reference lists were then reviewed to identify any additional relevant studies. Abstracts from international conferences were searched but were not included because they provided insufficient detail. Unpublished data were obtained through contact with experts in
Results
For information about the costs included in each study and the principal assumptions used in measuring effectiveness see webtable 1 (http://image.thelancet.com/extras/01art9117webtable1.pdf) and webtable 2 (http://image.thelancet.com/extras/01art9117webtable2.pdf). Table 3, Table 4 show the HIV prevalence rates that applied to the study populations, and unit costs and unit effectiveness for prevention (table 3) and treatment and care (table 4).
Discussion
Our results show that there are few studies of the cost-effectiveness of HIV/AIDS prevention, treatment, and care interventions in Africa, and there is considerable variability in the cost-effectiveness of such interventions. The most cost-effective interventions are for prevention of HIV/AIDS and treatment of tuberculosis, whereas HAART for adults, and home based care organised from health facilities, are the least cost effective. For some interventions, such as prevention of mother-to-child
References (48)
- et al.
Extent to which low-level use of antiretroviral treatment could curb the AIDS epidemic in sub-Saharan Africa
Lancet
(2000) - et al.
Benefits of HIV screening of blood transfusions in Zambia
Lancet
(1995) - et al.
Cost-effectiveness of improved treatment services for sexually transmitted diseases in preventing HIV-1 infection in Mwanza Region, Tanzania
Lancet
(1997) - et al.
Cost effectiveness of single dose nevirapine regimen for mothers and babies to decrease vertical transmission in sub-Saharan Africa
Lancet
(1999) - et al.
Cost effectiveness of chemotherapy for pulmonary tuberculosis in three sub-Saharan African countries
Lancet
(1991) - et al.
Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania
Lancet
(2000) An economic evaluation of alternative programme designs for tuberculosis control in rural Uganda
Soc Sci Med
(1995)- et al.
Prospects for worldwide tuberculosis control under the WHO DOTS strategy
Lancet
(1998) - et al.
Treatment outcome of an unselected cohort of tuberculosis patients in relation to human immunodeficiency virus serostatus in Zomba hospital, Malawi
Trans R Soc Trop Med Hyg
(1998) Public spending on health care: how are different criteria related?
Health Policy
(1999)
World Health Report 2000: Health systems: Improving performance
The Economic Impact of AIDS in Africa: a review of the literature. UNAIDS background paper for ADF 2000. AIDS: the greatest leadership challenge, Addis Ababa
European Commission, World Health Organization and Joint United Nations Programme on HIV/AIDS take a united stand against killer diseases
Fighting global AIDS: the value of cost- effectiveness analysis
AIDS
Systematic review on the cost- effectiveness of public health interventions for HIV prevention in industrialised countries
AIDS
Using cost-effectiveness league tables to compare interventions to prevent sexual transmission of HIV
AIDS
Cost-effectiveness and cost-benefit in the prevention of mother-to-child transmission of HIV in developing countries
AIDS
Methods for the economic evaluation of health care programmes
Cost-effectiveness of short course zidovudine to prevent perinatal HIV type 1 infection in a sub-Saharan African developing country setting
JAMA
Cost-effectiveness of antiviral drug therapy to reduce mother-to-child HIV transmission in sub-Saharan Africa
AIDS
Antiretroviral drugs as a public health intervention for pregnant HIV-infected women in rural South Africa: an issue of cost-effectiveness and capacity
AIDS
AIDS triple therapy for less than $1 per day
Cost effectiveness of tuberculosis preventive therapy for HIV-infected people in sub-Saharan Africa
AIDS
Cited by (311)
The power to protect: Household bargaining and female condom use
2021, Journal of Development EconomicsAIDS, human capital and development
2021, Review of Economic DynamicsNothing but the truth: Consistency and efficiency of the list experiment method for the measurement of sensitive health behaviours
2020, Social Science and MedicineThe Lazarus drug: the impact of antiretroviral therapy on economic growth
2020, Journal of Development EconomicsCitation Excerpt :Potentially important mechanisms include indirect labour market effects, such as funeral attendance or effects on the labour supply of carers of HIV-infected individuals.32 HIV treatment programs may also have reduced congestion in other public health services, improving health and increasing labour market participation for patients suffering from other conditions (Creese et al., 2002; Médecins Sans Frontières, 2015). Finally, indirect effects may also include changes in labour market or investment decisions that result from changes in beliefs about the risk and consequences of infection with HIV (Baranov et al., 2015; Baranov and Kohler, 2018).
Supporting Adolescents to Adhere (SATA): Lessons learned from an intervention to achieve medication adherence targets among youth living with HIV in Uganda
2019, Children and Youth Services ReviewCost-Effectiveness Analysis of Humanitarian Hand Surgery Trips According to WHO-CHOICE Thresholds
2019, Journal of Hand Surgery