Kostnadseffektivitet av HAART i forhold til forebyggende HIV/AIDS-tiltak i Afrika sør for Sahara

Abstract

Background

In 2003 The World’s Health Organization (WHO) and The Joint United Nations Programme on HIV/AIDS (UNAIDS) joined in the initiative to make antiretroviral therapy available to three million people by the end of 2005, known as the ”3 by 5”. WHO and UNAIDS have by this made the Highly Active Antiretroviral Therapy (HAART) top priority in the fight against HIV/AIDS. The recent price reductions have made these regimens more affordable, and put them economically within reach of more people in the developing countries. The current and future fight against HIV/AIDS will despite the price reductions on HAART have large economic costs, and attention has been drawn to identifying what kind of interventions are effective in maximising health and life. Since resources are limited, the cost-effectiveness of different HIV/AIDS-interventions may be both relevant and of great value in this respect, as well as urgently needed. Especially countries in sub-Saharan Africa (SSA) are suffering from HIV/AIDS, where the epidemic threatens to break down social and economic structures. In this paper, literature using cost-effectiveness analysis of HIV/AIDS-interventions in SSA was identified to explore what type of intervention is the most cost-effective in this region, and look at to what extent it is possible to draw such conclusions. Systematic reviews were especially sought for in order to make a more general comparison between preventive interventions and HAART, and to critically assess the existing evidence-base of both. Considerations regarding general ethics and limitations of a cost-effectiveness analysis are included.

Methods

A systematic search strategy of specific inclusion criteria was made to identify articles from the different databases, securing a body of relevant and central articles. More than 1500 articles number were assessed, 13 articles met the inclusion criteria and constituted the discussion of this paper. Background-literature was found both among these articles and as a result of an additional systematic search in the same databases.

Findings

There is a very limited evidence-base on the cost-effectiveness on HIV/AIDS-interventions in SSA, despite the duration of the epidemic and the range of interventions. Existing data on the cost-effectiveness of preventive activities are fragmented, and make it difficult to scientifically justify the priority of prevention before HAART in SSA. There are also large ethical problems in using theoretical cost-effectiveness analyses in this general decision-making, and in addition there are certain methodological limitations to this type of economic analysis.