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Equity and efficiency in HIV‐treatment in South Africa: the contribution of mathematical programming to priority setting
Author(s) -
Cleary Susan,
Mooney Gavin,
McIntyre Di
Publication year - 2010
Publication title -
health economics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.55
H-Index - 109
eISSN - 1099-1050
pISSN - 1057-9230
DOI - 10.1002/hec.1542
Subject(s) - equity (law) , scarcity , public economics , economics , psychological intervention , economic efficiency , actuarial science , health care , economic evaluation , government (linguistics) , economic growth , business , political science , medicine , microeconomics , psychiatry , law , linguistics , philosophy
The HIV‐epidemic is one of the greatest public health crises to face South Africa. A health care response to the treatment needs of HIV‐positive people is a prime example of the desirability of an economic, rational approach to resource allocation in the face of scarcity. Despite this, almost no input based on economic analysis is currently used in national strategic planning. While cost‐utility analysis is theoretically able to establish technical efficiency, in practice this is accomplished by comparing an intervention's ICER to a threshold level representing society's maximum willingness to pay to avoid death and improve health‐related quality of life. Such an approach has been criticised for a number of reasons, including that it is inconsistent with a fixed budget for health care and that equity is not taken into account. It is also impractical if no national policy on the threshold exists. As an alternative, this paper proposes a mathematical programming approach that is capable of highlighting technical efficiency, equity, the equity/efficiency trade‐off and the affordability of alternative HIV‐treatment interventions. Government could use this information to plan an HIV‐treatment strategy that best meets equity and efficiency objectives within budget constraints. Copyright © 2009 John Wiley & Sons, Ltd.