Browsing by Author "Skordis, Jolene"
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- ItemRestrictedComparing alternative measures of household income: evidence from the Khayelitsha/Mitchell's plain survey(Taylor & Francis, 2004) Skordis, Jolene; Welch, MatthewHousehold income is widely used for economic and sociological analysis, yet little emphasis has been placed on the optimal way to gather household income data. The Khayelitsha/Mitchell's Plain Survey provides a unique opportunity to explore alternative ways of measuring household income. This study compares the estimates obtained from a household module with those obtained from detailed income data collected in the adult module of the survey. Estimates derived from individual income data tend to be higher and have greater variation than those obtained from the household module. This difference between income estimates has a material impact on the secondary analysis of income data. The Gini coefficient, a simple measure of income-inequality, is used in this study to illustrate how household income measured at the household level underestimates household income inequality.
- ItemOpen AccessEconomic evaluation of health care : cautions for the developing country context(2002) Skordis, Jolene; Nattrass, NicoliHealth economics has expanded enormously as a sub-discipline in the last four decades, drawing primarily on the theoretical foundations of welfare economics. The toolkit for the economic evaluation of health care now extends from the humble cost-minimisation exercise, through cost effectiveness measures, to the more complex cost utility or cost benefit models. These methodologies have differing strengths and drawbacks. This paper evaluates those attributes on both the practical and theoretical dimensions. On the practical dimension: The developing country context differs from the wealthier country context in a number of ways. This paper considers the differences in resource constraints and the differences in health priorities and asks to what extent the methodology is able to accommodate these variations. On the theoretical dimension: Few health care evaluations are conducted in a Pareto Optimal world. This paper considers the extent to which the welfare economic foundations of a methodology are successfully imported into its construction, and then how that foundation translates into its practical application.
- ItemOpen AccessExploring the costs of a limited public sector antiretroviral treatment programme in South Africa(Health and Medical Publishing Group (HMPG), 2002) Boulle, Andrew; Kenyon, Christopher; Skordis, Jolene; Wood, RobinBackground: The role of antiretroviral treatment for adults in the pubic sector in South Africa is debated with little consideration of programme choices that could impact on the cost-effectiveness of the intervention. This study seeks to explore the impact of these programme choices at an individual level, as well as explore the total cost of a rationed national public sector antiretroviral treatment programme. Methods: Eight Scenarios were modelled of limited national treatment programmes over the next 5 years, reflecting different programme design choices. The individual costeffectiveness of these scenarios were compared. The total costs of the most cost-effective scenario were calculated, and the potential for savings in other areas of health care utilisation was explored. Results: The direct programme costs per life-year saved varied between scenarios from R5 923 to R11 829. All the costs of the most cost-effective scenario could potentially be offset depending on assumptions of health care access and utilisation. The total programme costs for the most costeffective scenario in 2007 with 107 000 people on treatment are around R409 million. Conclusion: Specific policy choices could almost double the number of people who could benefit from an investment in a limited national antiretroviral treatment programme. Such a programme is affordable within current resource constraints. The consideration of antiretroviral treatment calls for a unique public health approach to the rationing of health services in the public sector.
- ItemOpen AccessPaying to waste lives: the affordability of reducing mother-to-child transmission(2001) Skordis, Jolene; Nattrass, NicoliIt is estimated that each HIV-positive child in South Africa costs the government more in terms of health and welfare expenses than it does to reduce mother-to-child transmission (MTCT) of HIV through the use of antiretroviral regimens (where the mother continues to breast-feed). Programmes to reduce MTCT of HIV/AIDS are, thus, clearly affordable. Using Nevirapine (according to the HIVNET 012 Protocol) saves fewer lives, but is more cost-effective than using Zidovudine (CDC 2 weeks regime).
- ItemRestrictedPaying to waste lives: the affordability of reducing mother-to-child transmission of HIV in South Africa(Elsevier, 2002) Skordis, Jolene; Nattrass, NicoliIt is estimated that each HIV-positive child in South Africa costs the government more in terms of health and welfare expenses than it does to reduce mother-to-child transmission (MTCT) of HIV through the use of antiretroviral regimens (where the mother continues to breast-feed). Programmes to reduce MTCT of HIV/AIDS are, thus, clearly affordable. Using Nevirapine (according to the HIVNET 012 Protocol) saves fewer lives, but is more cost-effective than using Zidovudine (CDC 2 weeks regime).
- ItemOpen AccessThe ART of rationing - the need for a new approach to rationing health interventions(2003) Kenyon, Christopher; Skordis, Jolene; Boulle, Andrew; Pillay, KarrishaA key element in dealing with HIV/AIDS in South Africa depends on the resolution of the antiretroviral therapy (ART) paradox: while a universal First-World-style ART programme is unaffordable, a rationed treatment programme that includes ART is not only affordable but also vital for basic human rights reasons, to enhance prevention efforts and to keep the fabric of society together. Our recent paper on ART demonstrated how such a rationed programme would be both affordable and highly cost-effective. Traditional rationing mechanisms are unable to provide sufficient guidance as to how to go about this novel form of rationing. An alternative rationing mechanism is therefore proposed which seeks to balance ART in terms of three primary dimensions: total resource allocation to treatment, design of the treatment intervention, and setting targets on numbers to treat. Two secondary dimensions, related to total HIV and social spending, deserve equal attention. The current global context that precipitates and exacerbates the parallel contouring of disease burden and poverty should be constantly challenged.