Browsing by Author "MacDevette, Matthew"

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    Disease burden, cost modelling and the AIDS funding debate-towards clarity on whether the world is spending 'too much' on HIV/AIDS
    (2011) MacDevette, Matthew; Nattrass, Nicoli
    With pressures from the recent financial crisis forcing donors to carefully review their spending priorities, some have claimed, firstly, that HIV/AIDS receives too much money relative to its disease burden and, secondly, that the future costs of treating those with the disease will become unmanageable. This paper seeks to clarify each of these two areas...
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    Disease burden, proportionality and the AIDS funding debate-Towards clarity on whether the world is spending 'too much' on HIV/AIDS
    (2011) MacDevette, Matthew
    There is currently considerable uncertainty surrounding the future of HIV/AIDS funding. With pressures from the recent financial crisis forcing donors to carefully review their spending priorities, some have claimed that HIV/AIDS receives too much money relative to its disease burden. This paper seeks to clarify this issue by examining the proportionality of HIV/AIDS funding to its disease burden in the year 2008 by measuring that percentage of total health expenditure spent on HIV/AIDS against that percentage of total disease burden attributable to the disease. It pays particular attention to a recently raised issue; namely, whether substituting OECD data for UNAIDS data has any significant effect on the number of countries spending above or below the level that is proportional to their HIV/AIDS disease burdens. Results indicate that the majority of countries in the dataset 'overspend' on HIV/AIDS relative to the most commonly employed measure of disease burden, the Disability Adjusted Life Year (DALY). This result, however, belies the fact that global 'underspending' is far more severe than overspending; while most countries 'overspend', the total amount in surplus of proportionality in overspending countries is dwarfed by the total amount still needed to reach proportionality in underspending ones. In other words, global HIV/AIDS resources are inadequate to bring all countries' spending on the disease in line with their disease burdens.
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    Needling the entitlement balloon: Assumptions, cost projections and flaws in the Centre for Global Development's AIDSCost model
    (2011) MacDevette, Matthew
    The recently developed AIDSCost model was designed to forecast the future financial burden of global antiretroviral treatment (ART) up until 2050, and has been used to claim that ART treatment is too expensive for developing countries. This paper interrogates the structure and outputs of the AIDSCost model. Firstly, we investigate the model's assumptions and find a number of flaws in its makeup, the most significant being the unrealistic way in which ART coverage expands. These make it inappropriate for use in many real-world policy settings. Secondly, we compare the model's outputs for South Africa to those of ASSA2003, South Africa's most highly developed AIDS modelling tool, for the period 2007-2016 as a test of the former's accuracy. We find that, even when applying a number of different ART coverage and costing scenarios, AIDSCost overestimates the future burden of ART by as much as 100%. Though the model's costing function is disputable, the most serious errors underlie the calculation of vital outputs on which costing depends, most notably AIDS death rates, the number of those on ART and HIV prevalence. Accordingly, we argue that the model should be subjected to thorough refinement before it is used by anyone. Further, we argue that AIDSCost co-author Mead Over, in employing the model to show that "ballooning" ART burdens will overwhelm US aid budgets, generates unreliable figures which severely overestimate the future financial burden of global ART.