Policy Briefs on THE

ECONOMIC IMPACT OF HIV

Impact of HIV

Brief 16: Trade-offs within the HIV Budget

By Gesine Meyer-Rath, Kate L Harris, Markus Haacker

December 2021

Key Points

  • Governments need to choose between different HIV interventions in order to maximise impact under limited funding. This can be done by ordering interventions by cost-effectiveness in a league table, or by employing allocative efficiency models to determine how to allocate funds across packages of interventions in the most cost-effective way.

 

  • There can be a tension between cost-effectiveness (often expressed as cost per health outcome achieved, such as HIV infections averted or life-years saved) and other optimisation targets such as equitable access to services, or ending AIDS as a public health threat. Trade-offs also apply over time, as increasing the coverage of interventions today improves health outcomes but also affects spending needs in the future.

 

  • Decision-making is complicated by (a) declining returns to investment in individual interventions, (b) increasing marginal costs at high coverage levels, (c) interactions in effectiveness between different interventions and (d) a lack of effectiveness data for some interventions.

 

  • Additional practical constraints to achieving allocative efficiency include political promises from local and global actors, and budgetary inertia that makes drastic shifts across years difficult. These and the need for large amounts of data (and the risk of injurious advice given the uncertainty in the data) limit the usefulness of optimisation models, particularly for HIV programmes at high levels of intervention coverage.
Download PDF HIV Impact

Technical Briefs

The technical briefs provide more detail on the evidence available on each of the topics.

1. The State of Programme Implementation to Reduce HIV Transmission & Aids-Related Mortality

2. Increased Health and Life Prospects and Their Economic Valuation

3. HIV, Population Dynamics and the Labour Force

4. Human Capital

5. Capital and Investment

6. Productivity and Employment of People Living with HIV

7. Economic Growth – Overview

8. Interactions Between HIV and Poverty

9. Disease Burden Across Population Sub-Groups

10. Trade-offs between Allocation to Health and Other Sectors

11. Domestic Public Funding for HIV

12. Trade-offs and Synergies between HIV and Other Health Objectives

13. Assessing Cost Effectiveness Across HIV and Health Interventions

14. External and Domestic Health Financing, and the Role of Public vs. Private Domestic Health Funding

15. Public and Private Provision of Health and HIV Services

16. Trade-offs within the HIV Budget

17. The Economics of HIV and of HIV Programmes in the Era of Covid-19

Brief 16: Trade-offs within the HIV Budget

By Gesine Meyer-Rath, Kate L Harris, Markus Haacker

December 2021

Key Points

  • Governments need to choose between different HIV interventions in order to maximise impact under limited funding. This can be done by ordering interventions by cost-effectiveness in a league table, or by employing allocative efficiency models to determine how to allocate funds across packages of interventions in the most cost-effective way.
  • There can be a tension between cost-effectiveness (often expressed as cost per health outcome achieved, such as HIV infections averted or life-years saved) and other optimisation targets such as equitable access to services, or ending AIDS as a public health threat. Trade-offs also apply over time, as increasing the coverage of interventions today improves health outcomes but also affects spending needs in the future.
  • Decision-making is complicated by (a) declining returns to investment in individual interventions, (b) increasing marginal costs at high coverage levels, (c) interactions in effectiveness between different interventions and (d) a lack of effectiveness data for some interventions.

 

  • Additional practical constraints to achieving allocative efficiency include political promises from local and global actors, and budgetary inertia that makes drastic shifts across years difficult. These and the need for large amounts of data (and the risk of injurious advice given the uncertainty in the data) limit the usefulness of optimisation models, particularly for HIV programmes at high levels of intervention coverage.
Download PDF HIV Impact

Technical Briefs

The technical briefs provide more detail on the evidence available on each of the topics.

1. The State of Programme Implementation to Reduce HIV Transmission & Aids-Related Mortality

2. Increased Health and Life Prospects and Their Economic Valuation

3. HIV, Population Dynamics and the Labour Force

4. Human Capital

5. Capital and Investment

6. Productivity and Employment of People Living with HIV

7. Economic Growth – Overview

8. Interactions Between HIV and Poverty

9. Disease Burden Across Population Sub-Groups

10. Trade-offs between Allocation to Health and Other Sectors

11. Domestic Public Funding for HIV

12. Trade-offs and Synergies between HIV and Other Health Objectives

13. Assessing Cost Effectiveness Across HIV and Health Interventions

14. External and Domestic Health Financing, and the Role of Public vs. Private Domestic Health Funding

15. Public and Private Provision of Health and HIV Services

16. Trade-offs within the HIV Budget

17. The Economics of HIV and of HIV Programmes in the Era of Covid-19

Wits Health Consortium, University of the Witwatersrand