ARV Treatment: Special Focus
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The online conference is nearly complete, but we are still asking participants to put in their "final word" before we close this site next Friday, May 22. After May 22 the materials will be moved to the AIDS and Economics site on the World Bank server. So far we have had 117 registered participants from 28 countries. We have had 68 postings from 30 of the participants. For those who haven't posted yet, I'd encourage you to take this last week to review the materials and the summaries and provide your input. In addition to this online meeting, some of the participants were involved in a face-to-face meeting on Tuesday, May 12th that was organized by The Futures Group International and the World Bank (with USAID sponsorship). This meeting focused on the economics of HIV/AIDS prevention and treatment, as well as more specifically on the use of ARVs in developing countries. Final Questions to be Addressed: I would ask that participants consider a few questions during the last week of this discussion: 1. Is there agreement that there is a need for further work on the economics of ARVs in developing countries? If so, what should the agenda be for that research? 2. What form should this research take (cost-effectiveness analysis, cost-benefit analysis, willingness to pay, etc.)? Should equity be incorporated into the measures of effectiveness? If so, how? 3. Where can this research be carried out? Who will fund such research? 4. What do you think about the ARV Conference itself? Has it been interesting/useful to you? Would you interact with these people in a similar venue regarding other, economics-related topics? 5. If we were to host another discussion in 2 to 3 months, what should the topic be? We'd like to restrict ourselves to topics that have an important economic component related to HIV/AIDS. Summary of Last 2 Weeks The discussion during the last two weeks has provided some very interesting insights. A number of contributors have emphasized that we as economists need to pay greater attention to issues of equity, not just issues of effectiveness. Dr. Brunet-Jailly (Cote D'Ivoire) and Dr. Kerouedan (Madagascar) differed about whether or not ARVs should be offered in Africa. Yet both of them agreed that economists must look at AIDS within the entire context of the health systems in their countries. They both emphasized that there are extreme inequities in existing health structures, and that these inequities must be addressed. [message] [message] Dr. Albert (Canada) provided some fascinating information about inequities that exist in developed countries in regards to access to care. "Economists must begin to examine key ethical issues in order to provide a more holistic policy framework." Dr. Albert noted that there is a great deal of talk about equity, but eventually no one takes responsibility for incorporating such issues into their economic assessments. [message] In addition, Drs. Godwin (India) and Castillo (Peru) emphasized the need to collect more information. In the case of Peter Godwin, it was emphasized that further economic data is necessary, including analyses of health care costs, HIV-specific costs (including conventional and unconventional methods of health-seeking behavior), and indirect costs. Oswaldo Jave Castillo focused particularly on the need to collect information on operational and epidemiological issues. [message] [message] Finally, during the last few days, we have had an interesting discussion initiated by Dr. Cespedes (Colombia). Dr. Cespedes raises the issue of the affordability of ARVs in Colombia. He notes the importance of considering the number of people who are likely to require ARVs, and notes the very high cost of such provision if offered to all people living with AIDS. He then goes on to note that it may be affordable if the country were more selective in the patients who it offered these drugs to. This raises the very challenging conflict between effectiveness and equity. In order to make ARVs available in the country for some, it may be necessary to exclude others. The challenge is determining what criteria should be used. Dr. Cespedes notes that it may be possible to exclude those who have already been exposed to ARVs, people who are mentally ill, or people at the bottom line of the socio-economic spectrum who may not be able to comply with therapy. The problem is that if we exclude the poor because they are unlikely to comply with therapy, we may be further contributing to existing inequities in the health system. However, if we don't limit access to only those who can comply, we are likely to risk making these drugs unaffordable for everyone. [message] Dr. Izazola-Licea (Mexico) noted that models and projections of AIDS cases have often overestimated the course of the epidemic in Latin America. These inflated estimates of AIDS cases may now be used by some to argue against access to ARVs, since presumably it will be too expensive. Both Dr. Izazola-Licea and Dr. Flessa (Germany) argue that there need to be better projections of AIDS cases, as well as better estimates of the number of people who would actually request access to ARVs. [message] [message] Finally, in one of our first contributions from Asia, Dr. Uhrig (Vietnam) indicates that the cost of preventing one vertical infection through the use of AZT is likely to cost $10,000 in a low prevalence country such as Vietnam. It is therefore emphasized that the money would be much better spent on efforts into preventing youth and adult infections. [message] Thanks to everyone who has been contributing. I hope that you will continue to voice your opinion in forming an agenda for future work in this area. |
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