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Optimal Investment in a Portfolio of HIV Prevention Programs

Author

Listed:
  • Gregory S. Zaric

    (Ivey School of Business, University of Western Ontario, London, Ontario, Canada)

  • Margaret L. Brandeau

    (Department of Management Science and Engineering, Stanford University, Stanford, California)

Abstract

Objectives . In this article, the authors determine the optimal allocation of HIV prevention funds and investigate the impact of different allocation methods on health outcomes. Methods . The authors present a resource allocation model that can be used to determine the allocation of HIV prevention funds that maximizes quality-adjusted life years (or life years) gained or HIV infections averted in a population over a specified time horizon. They apply the model to determine the allocation of a limited budget among 3 types of HIV prevention programs in a population of injection drug users and nonusers: needle exchange programs, methadone maintenance treatment, and condom availability programs. For each prevention program, the authors estimate a production function that relates the amount invested to the associated change in risky behavior. Results . The authors determine the optimal allocation of funds for both objective functions for a high-prevalence population and a low-prevalence population. They also consider the allocation of funds under several common rules of thumb that are used to allocate HIV prevention resources. It is shown that simpler allocation methods(e.g., allocation based on HIV incidence or notions of equity among population groups) may lead to allocations that do not yield the maximum health benefit. Conclusions . The optimal allocation of HIV prevention funds in a population depends on HIV prevalence and incidence, the objective function, the production functions for the prevention programs, and other factors. Consideration of cost, equity, and social and political norms may be important when allocating HIV prevention funds. The model presented in this article can help decision makers determine the health consequences of different allocations of funds.

Suggested Citation

  • Gregory S. Zaric & Margaret L. Brandeau, 2001. "Optimal Investment in a Portfolio of HIV Prevention Programs," Medical Decision Making, , vol. 21(5), pages 391-408, October.
    • Handle: RePEc:sae:medema:v:21:y:2001:i:5:p:391-408
    DOI: 10.1177/0272989X0102100506
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    References listed on IDEAS

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    1. Kahn, J.G., 1996. "The cost-effectiveness of HIV prevention targeting: How much more bang for the buck?," American Journal of Public Health, American Public Health Association, vol. 86(12), pages 1709-1712.
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    Cited by:

    1. Amin Khademi & Denis R. Saure & Andrew J. Schaefer & Ronald S. Braithwaite & Mark S. Roberts, 2015. "The Price of Nonabandonment: HIV in Resource-Limited Settings," Manufacturing & Service Operations Management, INFORMS, vol. 17(4), pages 554-570, October.
    2. Stephanie Earnshaw & Katherine Hicks & Anke Richter & Amanda Honeycutt, 2007. "A linear programming model for allocating HIV prevention funds with state agencies: a pilot study," Health Care Management Science, Springer, vol. 10(3), pages 239-252, September.
    3. n/a, 2012. "Commentaries to "The Vital Role of Operations Analysis in Improving Healthcare Delivery"," Manufacturing & Service Operations Management, INFORMS, vol. 14(4), pages 495-511, October.
    4. Linus Nyiwul, 2021. "Epidemic Control and Resource Allocation: Approaches and Implications for the Management of COVID-19," Studies in Microeconomics, , vol. 9(2), pages 283-305, December.
    5. Ghayoori, Arash & Nagi, Rakesh, 2022. "A Markov model examining intervention effects on the HIV prevalence/incidence amongst the overall population," Socio-Economic Planning Sciences, Elsevier, vol. 79(C).
    6. Stephanie R. Earnshaw & Anke Richter & Stephen W. Sorensen & Thomas J. Hoerger & Katherine A. Hicks & Michael Engelgau & Ted Thompson & K. M. Venkat Narayan & David F. Williamson & Edward Gregg & Ping, 2002. "Optimal Allocation of Resources across Four Interventions for Type 2 Diabetes," Medical Decision Making, , vol. 22(1_suppl), pages 80-91, September.
    7. Wilson, Amy R. & Kahn, James G. & Oren, Shmuel S., 2005. "Targeting interventions to high-risk populations: Benefits and costs," Socio-Economic Planning Sciences, Elsevier, vol. 39(4), pages 335-349, December.
    8. Margaret L. Brandeau, 2016. "Creating impact with operations research in health: making room for practice in academia," Health Care Management Science, Springer, vol. 19(4), pages 305-312, December.
    9. McKenna, Claire & Chalabi, Zaid & Epstein, David & Claxton, Karl, 2010. "Budgetary policies and available actions: A generalisation of decision rules for allocation and research decisions," Journal of Health Economics, Elsevier, vol. 29(1), pages 170-181, January.
    10. Brandeau, Margaret L. & Zaric, Gregory S. & Richter, Anke, 2003. "Resource allocation for control of infectious diseases in multiple independent populations: beyond cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 22(4), pages 575-598, July.
    11. Konrad, Renata A., 2019. "Designing awareness campaigns to counter human trafficking: An analytic approach," Socio-Economic Planning Sciences, Elsevier, vol. 67(C), pages 86-93.
    12. Wilson, Amy R. & Kahn, James G., 2003. "Preventing HIV in injection drug users: exploring the tradeoffs between interventions," Socio-Economic Planning Sciences, Elsevier, vol. 37(4), pages 269-288, December.
    13. Sabina Alistar & Elisa Long & Margaret Brandeau & Eduard Beck, 2014. "HIV epidemic control—a model for optimal allocation of prevention and treatment resources," Health Care Management Science, Springer, vol. 17(2), pages 162-181, June.
    14. Zoë K. Harris, 2006. "Efficient allocation of resources to prevent HIV infection among injection drug users: the Prevention Point Philadelphia (PPP) needle exchange program," Health Economics, John Wiley & Sons, Ltd., vol. 15(2), pages 147-158, February.
    15. De Angelis, Vanda & Felici, Giovanni & Impelluso, Paolo, 2003. "Integrating simulation and optimisation in health care centre management," European Journal of Operational Research, Elsevier, vol. 150(1), pages 101-114, October.
    16. Jing Yao & Alan T. Murray, 2014. "Locational Effectiveness of Clinics Providing Sexual and Reproductive Health Services to Women in Rural Mozambique," International Regional Science Review, , vol. 37(2), pages 172-193, April.
    17. Lasry, Arielle & Zaric, Gregory S. & Carter, Michael W., 2007. "Multi-level resource allocation for HIV prevention: A model for developing countries," European Journal of Operational Research, Elsevier, vol. 180(2), pages 786-799, July.

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    2. Lasry, Arielle & Zaric, Gregory S. & Carter, Michael W., 2007. "Multi-level resource allocation for HIV prevention: A model for developing countries," European Journal of Operational Research, Elsevier, vol. 180(2), pages 786-799, July.
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