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HIV and health expenditures surveys : the need for data at individuals’ level

Pr Jean-Paul MOATTI University of Aix-Marseille 2 (France) INSERM/IRD Research Unit 912 SE4S Economic & Social Sciences, Health Systems & Societies. HIV and health expenditures surveys : the need for data at individuals’ level. THE CONTEXT.

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HIV and health expenditures surveys : the need for data at individuals’ level

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  1. Pr Jean-Paul MOATTIUniversity of Aix-Marseille 2 (France) INSERM/IRD Research Unit 912 SE4S Economic & Social Sciences, Health Systems & Societies HIV and health expenditures surveys : the need for data at individuals’ level

  2. THE CONTEXT • Health economic literature = strong inefficiencies in health systems (in general and exacerbated in developing countries) • Heterogeneity in unit costs for delivering HIV services (beyond economies of scale & scope) • International and domestic funding bodies asking for information about « value for money »

  3. Scale and Average Unit Cost of VCT programs in 5 countries 1,000 100 US$ Average Unit Costs 10 1 1 10 100 1,000 10,000 100,000 Annual clients receiving VCT Mexico Uganda Russia India South Africa Source: Preliminary analysis of PANCEA data. Unpublished data. 2006

  4. THE CONTEXT • Health economic literature = strong inefficiencies in health systems (in general and exacerbated in developing countries) • Heterogeneity in unit costs for delivering HIV services (beyond economies of scale & scope) • International and domestic funding bodies asking for information about « value for money »

  5. THE METHODOLOGICAL TRADE-OFF • Inter-countries and Intra-country comparisons => standardizedeasy to collectindicators…..but = High risk of misinterpretations (econometricresults sensitive to heterogeneity of biases in data collection and modelsspecification) VS • Population surveys and patients’cohorts=> detailed data atindividuals’ or households’ level = more amenable forproperanalysis….but = increasedimplementationdifficulties on a routine basis

  6. THREE EXAMPLES OF THE USE OF INDIVIDUAL DATA • ARV source prices (Brazil) (Meiners et al., Vienna Conference, THAE0205- Thursday 22nd) • EVAL-ANRS survey among HIV+ patients in health care centers (Cameroon) (Boyer et al., AIDS 2010, 24: S5-S15) • Micro-simulation of DHS data for macro-economic impact estimation of alternative scenarios (Cameroon, Swaziland, Tanzania) (UNAIDS, 2010)

  7. Data and methods (Brazil) • Object: adult ARV transactions (2009 USD) • Analysedperiod: 1996 - 2009 • Data: transaction, drug and marketcharacteristics • Source: Dept of STD, AIDS and VH, MoH

  8. Results Coverage and mean ARV expenditures (Brazil) N=607

  9. Results PYD according to supply type (Brazil)

  10. CAMEROON: the EVAL – ANRS 12 116 research project • Cross-sectional and multicentre study (Sept., 2006 to Apr., 2007) • 3151 HIV infected adults interviewed in 27 HIV services at the 3 levels of the healthcare delivery (Central; Provincial; District) • Random sample • Face-to-face interview and anonymous questionnaires • Medical information card and blood sample (CD4 cell counts) • Response rate: 91% • 97 physicians in the same 27 HIV services • All-inclusive • Anonymously self-reported questionnaires • Data on characteristics of healthcare services • Data on decentralization policy

  11. CAMEROON • Direct out-of-pocket costs related to HIV infection(by month – median)(n=2412 ART-treated pts) - Catastrophic Health Expenditures (≥ 20% households’ resources) : 44%

  12. CAMEROON EVAL ANRS SurveyFactors associated with the risk of catastrophic health exp.* (n=2412)

  13. Estimates of alternative scenarios of scaling-up of ART treatment in an agent-based microsimulation model Ventelou(1,2), Arrighi(1,2), Afridi(1,2), Greener(3), Lamontagne(3), Moatti(2) Contact Author: (1) CNRS GREQAM / INSERM Unit 912 and PACA Regional Center for Disease Control (2) INSERM Unit 912 and PACA Regional Center for Disease Control (3) UNAIDS

  14. DATA • CAMEROUN • 2004 Cameroon Demographic and Health Survey (EDSC III) • Large dataset : 35,000 individuals sampled • Numerous data on socio-economics and perception of AIDS • 10,900 Adults aged15-49 are retained • Linked with a HIV Blood Test Record- • 9,551 tests were performed • Results in a Sample of 8,186 HIV+ and HIV- individuals • 46.2% Men ; 53.8% Women (weighted) • HIV Prevalence = 7.5% (weighted) • Every Individual represents xxx

  15. METHODS: Dynamics • Agents in the database are: HIVnegative / HIVpositive / HIVpositive+needing ART The proportion of PLWHIV needing ART has been obtained from WHO data (not given in the dataset) - differentiated across age classes and genders, for taking into account a probable longer date of infection among the oldest. We randomly assign agents to the HIV+TN status • 4 Status: Future states = obtained by artificial “ageing” (Markov)

  16. RESULTSEconomics - Cameroun • CBA: Aid Freeze vs. Universal Access • Universal Access dominates Aid Freeze only on the long-run • Gains are lower (GDP per capita...)

  17. Ad-Hoc Technical Advisory Group on Costing HIV/AIDS Interventions (WHO, GFATM, PEPFAR)- June 2010 “WHO and partners should go forward with two levels of program-level ART costing: a routine data collection across a few basic cost categories at national level; and secondly a more detailed exercise to guide countries in producing reliable cost figures for comparative analysis”

  18. Recommendations Need of Multi-country/multi-sites surveys with individual data on HIV expenditures Need of an Operational Research pooled mechanism

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