HIV/AIDS accounts for around 20% of all deaths in Africa. The cost-effectiveness of interventions is important as African governments face difficult choices in striking the right balance between prevention, treatment, and care, all of which are necessary to deal with the HIV/AIDS epidemic. Andrew Creese from WHO, Geneva, Switzerland, and colleagues assessed existing data and their implications for value-for-money strategies to combat HIV/AIDS in Africa.

The investigators identified over 60 reports that measured cost and effectiveness of HIV/AIDS interventions. 24 studies were used to calculate standardised estimates of cost (US$) per HIV infection prevented and cost per disability-adjusted life-year (DALY) gained for 31 interventions.

Cost-effectiveness varied greatly between interventions. A case of HIV/AIDS could be prevented for $11, and a DALY gained for $1, by selective blood safety measures, and by targeted condom distribution with treatment of sexually transmitted diseases. Single-dose nevirapine and short-course zidovudine for prevention of mother-to-child transmission, voluntary counselling and testing, and tuberculosis treatment cost under $75 per DALY gained. Other interventions (eg. formula feeding for infants, home care programmes, and antiretroviral therapy for adults) cost several thousand dollars per infection prevented, or several hundreds of dollars per DALY gained.

Andrew Creese comments: Allocation of new funds for HIV/AIDS requires more than rankings of cost-effectiveness. Nevertheless, value for money is important, especially in African countries, where resources are particularly scarce and needs are so great. Existing cost-effectiveness data are few, and much more high quality research is needed for detailed planning and pro
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Contact: Richard Lane
richard.lane@lancet.com
44-20-7424-4949
Lancet
9-May-2002