Designing an optimal HIV programme for South Africa : Does the optimal package change when diminishing returns are considered?
BACKGROUND: South Africa has a large domestically funded HIV programme with highly saturated coverage levels for most prevention and treatment interventions. To further optimise its allocative efficiency, we designed a novel optimisation method and examined whether the optimal package of interventions changes when interaction and non-linear scale-up effects are incorporated into cost-effectiveness analysis.
METHODS: The conventional league table method in cost-effectiveness analysis relies on the assumption of independence between interventions. We added methodology that allowed the simultaneous consideration of a large number of HIV interventions and their potentially diminishing marginal returns to scale. We analysed the incremental cost effectiveness ratio (ICER) of 16 HIV interventions based on a well-calibrated epidemiological model that accounted for interaction and non-linear scale-up effects, a custom cost model, and an optimisation routine that iteratively added the most cost-effective intervention onto a rolling baseline before evaluating all remaining options. We compared our results with those based on a league table.
RESULTS: The rank order of interventions did not differ substantially between the two methods- in each, increasing condom availability and male medical circumcision were found to be most cost-effective, followed by anti-retroviral therapy at current guidelines. However, interventions were less cost-effective throughout when evaluated under the optimisation method, indicating substantial diminishing marginal returns, with ICERs being on average 437% higher under our optimisation routine.
CONCLUSIONS: Conventional league tables may exaggerate the cost-effectiveness of interventions when programmes are implemented at scale. Accounting for interaction and non-linear scale-up effects provides more realistic estimates in highly saturated real-world settings.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:17 |
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| Enthalten in: |
BMC public health - 17(2017), 1 vom: 31. Jan., Seite 143 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Chiu, Calvin [VerfasserIn] |
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| Links: |
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| Themen: |
Cost-effectiveness analysis |
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| Anmerkungen: |
Date Completed 04.09.2017 Date Revised 02.12.2018 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s12889-017-4023-3 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: South Africa has a large domestically funded HIV programme with highly saturated coverage levels for most prevention and treatment interventions. To further optimise its allocative efficiency, we designed a novel optimisation method and examined whether the optimal package of interventions changes when interaction and non-linear scale-up effects are incorporated into cost-effectiveness analysis | ||
| 520 | |a METHODS: The conventional league table method in cost-effectiveness analysis relies on the assumption of independence between interventions. We added methodology that allowed the simultaneous consideration of a large number of HIV interventions and their potentially diminishing marginal returns to scale. We analysed the incremental cost effectiveness ratio (ICER) of 16 HIV interventions based on a well-calibrated epidemiological model that accounted for interaction and non-linear scale-up effects, a custom cost model, and an optimisation routine that iteratively added the most cost-effective intervention onto a rolling baseline before evaluating all remaining options. We compared our results with those based on a league table | ||
| 520 | |a RESULTS: The rank order of interventions did not differ substantially between the two methods- in each, increasing condom availability and male medical circumcision were found to be most cost-effective, followed by anti-retroviral therapy at current guidelines. However, interventions were less cost-effective throughout when evaluated under the optimisation method, indicating substantial diminishing marginal returns, with ICERs being on average 437% higher under our optimisation routine | ||
| 520 | |a CONCLUSIONS: Conventional league tables may exaggerate the cost-effectiveness of interventions when programmes are implemented at scale. Accounting for interaction and non-linear scale-up effects provides more realistic estimates in highly saturated real-world settings | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cost-effectiveness analysis | |
| 650 | 4 | |a HIV | |
| 650 | 4 | |a Health economics | |
| 650 | 4 | |a Modelling | |
| 650 | 4 | |a Optimisation | |
| 650 | 4 | |a South Africa | |
| 700 | 1 | |a Johnson, Leigh F |e verfasserin |4 aut | |
| 700 | 1 | |a Jamieson, Lise |e verfasserin |4 aut | |
| 700 | 1 | |a Larson, Bruce A |e verfasserin |4 aut | |
| 700 | 1 | |a Meyer-Rath, Gesine |e verfasserin |4 aut | |
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