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Equity and efficiency in HIV‐treatment in South Africa: the contribution of mathematical programming to priority setting

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  • Susan Cleary
  • Gavin Mooney
  • Di McIntyre

Abstract

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.

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  • Susan Cleary & Gavin Mooney & Di McIntyre, 2010. "Equity and efficiency in HIV‐treatment in South Africa: the contribution of mathematical programming to priority setting," Health Economics, John Wiley & Sons, Ltd., vol. 19(10), pages 1166-1180, October.
    • Handle: RePEc:wly:hlthec:v:19:y:2010:i:10:p:1166-1180
    DOI: 10.1002/hec.1542
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    References listed on IDEAS

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    Cited by:

    1. Stephen Birch & Amiram Gafni, 2012. "Decision Rules in Economic Evaluation Revisited," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 49, Edward Elgar Publishing.
    2. James Love-Koh & Susan Griffin & Edward Kataika & Paul Revill & Sibusiso Sibandze & Simon Walker & Jessica Ochalek & Mark Sculpher & Matthias Arnold, 2019. "Economic analysis for health benefits package design," Working Papers 165cherp, Centre for Health Economics, University of York.
    3. Morton, Alec & Thomas, Ranjeeta & Smith, Peter C., 2016. "Decision rules for allocation of finances to health systems strengthening," Journal of Health Economics, Elsevier, vol. 49(C), pages 97-108.
    4. Morton, Alec, 2014. "Aversion to health inequalities in healthcare prioritisation: A multicriteria optimisation perspective," Journal of Health Economics, Elsevier, vol. 36(C), pages 164-173.

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