UCSF health economists urge global AIDS fund to finance prevention first

Funding proven HIV prevention interventions in sub-Saharan Africa is 28 times more cost-effective than funding highly active antiretroviral therapy (HAART), even when HAART is priced extremely conservatively, according to UCSF researchers.

Focusing first on relatively inexpensive prevention efforts such as ensuring a safe blood supply, using antiretrovirals to prevent mother to child transmission of HIV, voluntary counseling and testing, and sex worker intervention programs will save the maximum number of lives with the limited funds available, said Elliot Marseille, DrPH, MPP, principal research associate at UCSFs Institute for Health Policy Studies and lead author of the article which appears in the May 25, 2002 issue of The Lancet. Marseille is also affiliated with UCSFs AIDS Research Institute.

Pointing out that spending money on HIV prevention is at least 28 times as efficient in saving lives as spending the same money on HAART generates controversy. But since the Global AIDS Fund has received commitments to date totaling only one-fifth of what will be needed every single year to provide for both prevention and treatment, we cannot duck the question, Where can this money do the most good? said Marseille.

The article assigns a conservative cost for the delivery of HAART--$350 per disability-adjusted life year (DALY). DALY is the standardized measure of health benefit that reflects years of life saved by an intervention adjusted for the quality and socio-economic value of each life-year saved.

The $350 cost is based on the lowest available discount price for the standard three-drug combination therapy for one person for one year that has been offered by the Indian generic manufacturer, Cipla, to Medicins Sans Frontieres. No other costs are attributed to the delivery of HAART for the purposes of the cost-effectiveness comparison with prevention programs. The $350 estimate also assumes perfect adherence to the drugs and no in

Contact: Jeff Sheehy
University of California - San Francisco

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