National HIV Prevention Conference Atlanta, Georgia, USA — July 27 - 30, 2003

Natl HIV Prev Conf 2003 July 27-30:abstract no. M1-E0604
Holtgrave D
Emory University School of Public Health, Atlanta, GA

BACKGROUND/OBJECTIVES:: Cost-effectiveness analysis (CEA) is a form of quantitative policy analysis designed to examine and summarize the resources consumed -- and health consequences caused -- by a particular public health program or intervention relative to some other public health activity.a particular form of CEA -- cost-utility analysis (CUA) -- has been recommended by the U.S. Panel on Cost-effectiveness in Health and Medicine. CUA expresses resources consumed and health benefits derived as a cost-per-quality-adjusted-life-year saved (cost-per-qaly saved) ratio; it is often performed under conditions of uncertainty and explicitly models this uncertainty in the analysis. CUA can be used to inform policy makers who must make decisions across disease areas (e.g., decisions that pit hiv prevention against cancer prevention expenditures), as well as inform policy makers who must prioritize activities within one disease area (i.e., decisions that pit several different types of hiv prevention programs against each other). The purpose of the present paper is to review the actual utilization of CUA; in particular, to discuss in detail some cases in which cua has been used, and cases ideally suited to its use but in which CUA was not considered or ignored. Further, we discuss the consequences of considering (or not considering) CUA in public health decision making.

METHODS: We examined three cases in detail. First, we reviewed the Office of Management and Budget's (OMB's) policies and presentations by their key personnel regarding the current, potential and preferred uses of CUA. Second, we examined the available literature on the experiences of HIV prevention community planning groups and state health departments in the use of CUA. Third, we reviewed the cost-effectiveness literature relevant to all four components of CDC's recent "Advancing HIV Prevention" initiative and considered its potential uses in putting forth that initiative.

RESULTS: First, OMB has clearly articulated a role for cost-benefit analysis in the past and has stated a desire to couple that form of analysis with cua in the future. Second, the use of CUA by community planning groups has been mixed and highly varied; reasons for this variation have been identified in the literature and are discussed here. Third, the four components of CDC's Advancing HIV Prevention initiative have widely varying cua literatures; some components have a clear basis in CUA while others do not (at least not given the current state of the literature which has yet to examine some aspects of this initiative in detail). This appears to indicate that some other factors besides extant, published CUAs may have been considered in promoting some of the components in this initiative.

CONCLUSIONS: While CUA is ideally suited to policy making, and it is endorsed by policy making bodies, its use to date in practice appears mixed. We discuss the potential public health consequences of this variation in use, and describe suggestions for increased yet practical utilization of cua in the future.

030727
M1-E0604

Copyright notice: The National HIV Prevention Conference is collaborative effort by the Centers for Disease Control and Prevention, a U.S. Government agency and other governmental and non-government organizations. All abstracts published in by the conference organizers are in the public domain and can be used without permission. Proper citation, however, is required.