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Three levels of economic evaluation that should be distinguished

8th International Conference on psychosocial and economic aspects of HIV infection www.aidsimpact.net. Three levels of economic evaluation that should be distinguished. 1 Economic calculus to identify optimal strategies from the point of view of society

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Three levels of economic evaluation that should be distinguished

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  1. 8th International Conference on psychosocial and economic aspects of HIV infectionwww.aidsimpact.net

  2. Three levels of economic evaluation that should be distinguished • 1 Economic calculus to identify optimal strategies from the point of view of society • 2 Determinants of variability of « real » practices • 3 Evaluation of best public policies to reduce the gap between optimal and real practices

  3. Classement coût/efficacité d’une stratégie nouvelle par rapport au standard médical de référence Coûts (+) Plus chère, moins efficace Plus chère, plus efficace Ä Stratégie dominée Combien est-on prêt à payer en plus pour avoir plus d’efficacité ? Þ Rejet (-) (+) Résultat médical : efficacité, utilité Moins chère, moins efficace Moins chère, plus efficace Ä Stratégie dominante Combien est-on prêt à perdre en efficacité pour réduire les coûts ? Þ Adoption (-)

  4. Cost-effectiveness analysis is a normative tool • Appropriate to allocate resources between mutually exclusive strategies (= comparing different alternatives of reaching an identical goal) • Examples: • Optimal CD4 level for initiating ARV therapy • Criteria for switching to 2nd line therapy • Best ARV combination for first-line therapy • Best monitoring for decentralized supply of ARV

  5. Cost-effectiveness analysis is a normative tool • A lot less appropriate to allocate resources between mutually compatible strategies (= comparing different programs with different goals) • Examples: • Prevention vs ARV therapy • HIV care vs care of other pathologies

  6. Cost-effectiveness analysis is not a management tool • Absolutely not appropriate to understand why actual practices may have significant differences in productivity • Econometric analysis and operational research are more appropriate tools

  7. 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

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