Designing an optimal HIV programme for South Africa: Does the optimal package change when diminishing returns are considered?

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dc.contributor.authorChiu, Calvin
dc.contributor.authorJohnson, Leigh F
dc.contributor.authorJamieson, Lise
dc.contributor.authorLarson, Bruce A
dc.contributor.authorMeyer-Rath, Gesine
dc.date.accessioned2021-10-08T06:54:51Z
dc.date.available2021-10-08T06:54:51Z
dc.date.issued2017
dc.description.abstractAbstract Background South Africa has a large domestically funded HIV programme with highly saturated coverage levels for most prevention and treatment interventions. To further optimise its allocative efficiency, we designed a novel optimisation method and examined whether the optimal package of interventions changes when interaction and non-linear scale-up effects are incorporated into cost-effectiveness analysis. Methods The conventional league table method in cost-effectiveness analysis relies on the assumption of independence between interventions. We added methodology that allowed the simultaneous consideration of a large number of HIV interventions and their potentially diminishing marginal returns to scale. We analysed the incremental cost effectiveness ratio (ICER) of 16 HIV interventions based on a well-calibrated epidemiological model that accounted for interaction and non-linear scale-up effects, a custom cost model, and an optimisation routine that iteratively added the most cost-effective intervention onto a rolling baseline before evaluating all remaining options. We compared our results with those based on a league table. Results The rank order of interventions did not differ substantially between the two methods- in each, increasing condom availability and male medical circumcision were found to be most cost-effective, followed by anti-retroviral therapy at current guidelines. However, interventions were less cost-effective throughout when evaluated under the optimisation method, indicating substantial diminishing marginal returns, with ICERs being on average 437% higher under our optimisation routine. Conclusions Conventional league tables may exaggerate the cost-effectiveness of interventions when programmes are implemented at scale. Accounting for interaction and non-linear scale-up effects provides more realistic estimates in highly saturated real-world settings.
dc.identifier.apacitationChiu, C., Johnson, L. F., Jamieson, L., Larson, B. A., & Meyer-Rath, G. (2017). Designing an optimal HIV programme for South Africa: Does the optimal package change when diminishing returns are considered?. <i>BMC Public Health</i>, 17(1), 174 - 177. http://hdl.handle.net/11427/34356en_ZA
dc.identifier.chicagocitationChiu, Calvin, Leigh F Johnson, Lise Jamieson, Bruce A Larson, and Gesine Meyer-Rath "Designing an optimal HIV programme for South Africa: Does the optimal package change when diminishing returns are considered?." <i>BMC Public Health</i> 17, 1. (2017): 174 - 177. http://hdl.handle.net/11427/34356en_ZA
dc.identifier.citationChiu, C., Johnson, L.F., Jamieson, L., Larson, B.A. & Meyer-Rath, G. 2017. Designing an optimal HIV programme for South Africa: Does the optimal package change when diminishing returns are considered?. <i>BMC Public Health.</i> 17(1):174 - 177. http://hdl.handle.net/11427/34356en_ZA
dc.identifier.issn1471-2458
dc.identifier.ris TY - Journal Article AU - Chiu, Calvin AU - Johnson, Leigh F AU - Jamieson, Lise AU - Larson, Bruce A AU - Meyer-Rath, Gesine AB - Abstract Background South Africa has a large domestically funded HIV programme with highly saturated coverage levels for most prevention and treatment interventions. To further optimise its allocative efficiency, we designed a novel optimisation method and examined whether the optimal package of interventions changes when interaction and non-linear scale-up effects are incorporated into cost-effectiveness analysis. Methods The conventional league table method in cost-effectiveness analysis relies on the assumption of independence between interventions. We added methodology that allowed the simultaneous consideration of a large number of HIV interventions and their potentially diminishing marginal returns to scale. We analysed the incremental cost effectiveness ratio (ICER) of 16 HIV interventions based on a well-calibrated epidemiological model that accounted for interaction and non-linear scale-up effects, a custom cost model, and an optimisation routine that iteratively added the most cost-effective intervention onto a rolling baseline before evaluating all remaining options. We compared our results with those based on a league table. Results The rank order of interventions did not differ substantially between the two methods- in each, increasing condom availability and male medical circumcision were found to be most cost-effective, followed by anti-retroviral therapy at current guidelines. However, interventions were less cost-effective throughout when evaluated under the optimisation method, indicating substantial diminishing marginal returns, with ICERs being on average 437% higher under our optimisation routine. Conclusions Conventional league tables may exaggerate the cost-effectiveness of interventions when programmes are implemented at scale. Accounting for interaction and non-linear scale-up effects provides more realistic estimates in highly saturated real-world settings. DA - 2017 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Public Health LK - https://open.uct.ac.za PY - 2017 SM - 1471-2458 T1 - Designing an optimal HIV programme for South Africa: Does the optimal package change when diminishing returns are considered? TI - Designing an optimal HIV programme for South Africa: Does the optimal package change when diminishing returns are considered? UR - http://hdl.handle.net/11427/34356 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34356
dc.identifier.vancouvercitationChiu C, Johnson LF, Jamieson L, Larson BA, Meyer-Rath G. Designing an optimal HIV programme for South Africa: Does the optimal package change when diminishing returns are considered?. BMC Public Health. 2017;17(1):174 - 177. http://hdl.handle.net/11427/34356.en_ZA
dc.language.isoeng
dc.publisher.departmentCentre for Infectious Disease Epidemiology and Research
dc.publisher.facultyFaculty of Health Sciences
dc.sourceBMC Public Health
dc.source.journalissue1
dc.source.journalvolume17
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12889-017-4023-3
dc.subject.otherCost-effectiveness analysis
dc.subject.otherHIV
dc.subject.otherHealth economics
dc.subject.otherModelling
dc.subject.otherOptimisation
dc.subject.otherSouth Africa
dc.subject.otherCircumcision, Male
dc.subject.otherCost-Benefit Analysis
dc.subject.otherFemale
dc.subject.otherHIV Infections
dc.subject.otherHIV Seropositivity
dc.subject.otherHealth Promotion
dc.subject.otherHumans
dc.subject.otherMale
dc.subject.otherProgram Development
dc.subject.otherSouth Africa
dc.titleDesigning an optimal HIV programme for South Africa: Does the optimal package change when diminishing returns are considered?
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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