Taking an Economic Approach to Evaluating HIV Programs in Australia
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Taking an Economic Approach to Evaluating HIV programs in Australia Jonathan Anderson Student Number 3056666 1 PLEASE TYPE THE UNIVERSITY OF NEW SOUTH WALES Thesis/Dissertation Sheet Surname or Family name: Anderson First name: Jonathan Other name/s:St Clair Abbreviation for degree as given in the University calendar: PhD School: The Kirby Institute Faculty:Medicine Title: Taking an economic approach to evaluating HIV programs in Australia Abstract 350 words maximum: (PLEASE TYPE) Research program aimed to assess whether Assessing Cost Effectiveness (ACE) approach could be used in priority setting process to assess interventions for treatment and prevention of HIV in Australia that stakeholders could understand and be engaged in, and that would provide insights that would be useful, relevant and illuminating. Three linked studies of ACE-HIV supported by two studies measuring cost and patient-reported outcomes of people living with HIV in Australia. Chapter 1 is literature review on HIV interventions in high-income countries. There were few published studies on economic evaluations of interventions for the prevention and treatment of HIV in Australia and few studies of interventions that were relevant in 2008. Chapter 2 reports study using a novel method to derive cost data for 10,951 people living with HIV from Medicare Australia. Data from this study were combined with other available data to estimate total cost of HIV healthcare in Australia for use in models of ACE-HIV project. Study found that it was possible to use Medicare Australia database to estimate costs of HIV healthcare claimed through the Medicare Benefits Schedule. Chapter 3 describes original study measuring health-related utility in people living with HIV in era of effective antiretrovirals. Australian utility instrument (AQoL) was used for first time in HIV in a sample drawn from existing cohort with available clinical and surrogate data. AQoL was reasonably acceptable for use in sub-set of cohort of HIV patients, but low correlation in scores was seen with different health states associated with HIV. Chapter 4 reports Assessing Cost-Effectiveness in HIV (ACE-HIV) project, priority-setting exercise that consisted of systematic approach to economic evaluation applied to six different interventions for HIV prevention and healthcare in Australia. The group ranked the interventions according to the economic model results and then re-ranked them after considering non-economic factors. Chapter 5 reports method, results and discussions of six cost-effectiveness analyses performed for ACE-HIV project. Chapter 6. Thesis concludes that ACE approach could be a sound and useful approach for priority-setting in HIV medicine in Australia and that data required for the economic evaluations could be gathered from existing databases and cohorts. Declaration relating to disposition of project thesis/dissertation 1h ereby grant to the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or in part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all property rights, such as patent rights. I also retain the right to use in future works (such as articles or books) a ll or part of this thesis or dissertation. 1 also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstracts International (this is applicable to doctoral theses only). ...........~~ ---··· ····· · ..........6 .1.... ~+. : . 1. 2 .............. Signature Witness Date The University recognises that there may be exceptional circumstances requiring restrictions on copying or conditions on use. Requests for restriction for a period of up to 2 years must be made in writing. Requests for a longer period of restriction may be considered in exceptional circumstances andre uire the a roval of the Dean of Graduate Research. FOR OFFICE USE ONLY Date of completion of requirements lor Award: THIS SHEET IS TO BE GLUED TO THE INSIDE FRONT COVER OF THE THESIS COPYRIGHT STATEMENT ‘I hereby grant the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all proprietary rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstract International (this is applicable to doctoral theses only). I have either used no substantial portions of copyright material in my thesis or I have obtained permission to use copyright material; where permission has not been granted I have applied/will apply for a partial restriction of the digital copy of my thesis or dissertation.' Signed ……………………………………………........................... Date ……09/May/2013……………………........................... AUTHENTICITY STATEMENT ‘I certify that the Library deposit digital copy is a direct equivalent of the final officially approved version of my thesis. No emendation of content has occurred and if there are any minor variations in formatting, they are the result of the conversion to digital format.’ Signed ……………………………………………........................... Date ………09/05/2013……………………………………........................... ORIGINALITY STATEMENT ‘I hereby declare that this submission is my own work and to the best of my knowledge it contains no materials previously published or written by another person, or substantial proportions of material which have been accepted for the award of any other degree or diploma at UNSW or any other educational institution, except where due acknowledgement is made in the thesis. Any contribution made to the research by others, with whom I have worked at UNSW or elsewhere, is explicitly acknowledged in the thesis. I also declare that the intellectual content of this thesis is the product of my own work, except to the extent that assistance from others in the project's design and conception or in style, presentation and linguistic expression is acknowledged.’ Signed …………………………………………….............. Date ………31 July 2012…………………………………….............. Index Introduction Introduction to purpose and structure of thesis 3 Chapter 1 Literature review of economic evaluations of HIV interventions 11 Chapter 2 HIV healthcare: costs and resource use 51 Chapter 3 Measuring health‐related utility in people living with HIV 82 Chapter 4 Assessing Cost‐Effectiveness in HIV (ACE‐HIV) project 107 Chapter 5 The ACE‐HIV Economic evaluations 135 Chapter 6 Discussion and Conclusions 196 References References 219 Appendix A EURONHEED questionnaire 242 Appendix B Instruments used in Chapter 3 245 Journal article. Cost‐Effectiveness of Adult Circumcision Appendix C in a Resource‐Rich Setting for HIV Prevention 255 among Men Who Have Sex with Men. JID 2009 Appendix D Pamphlet 8 from ACE‐Prevention 265 Glossary Acronyms and abbreviations 2 Abstract Research program aimed to assess whether Assessing Cost Effectiveness (ACE) approach could be used in priority setting process to assess interventions for treatment and prevention of HIV in Australia that stakeholders could understand and be engaged in, and that would provide insights that would be useful, relevant and illuminating. Three linked studies of ACE-HIV supported by two studies measuring cost and patient-reported outcomes of people living with HIV in Australia. Chapter 1 is literature review on HIV interventions in high-income countries. There were few published studies on economic evaluations of interventions for the prevention and treatment of HIV in Australia and few studies of interventions that were relevant in 2008. Chapter 2 reports study using a novel method to derive cost data for 10,951 people living with HIV from Medicare Australia. Data from this study were combined with other available data to estimate total cost of HIV healthcare in Australia for use in models of ACE-HIV project. Study found that it was possible to use Medicare Australia database to estimate costs of HIV healthcare claimed through the Medicare Benefits Schedule. Chapter 3 describes original study measuring health-related utility in people living with HIV in era of effective antiretrovirals. Australian utility instrument (AQoL) was used for first time in HIV in a sample drawn from existing cohort with available clinical and surrogate data. AQoL was reasonably acceptable for use in sub-set of cohort of HIV patients, but low correlation in scores was seen with different health states associated with HIV. Chapter 4 reports Assessing Cost-Effectiveness in HIV (ACE-HIV) project, priority- setting exercise that consisted of systematic approach to economic evaluation applied to six different interventions for HIV prevention and healthcare in Australia. The group ranked the interventions according to the economic model results and then re-ranked them after considering non-economic factors. Chapter 5 reports method, results and discussions of six cost-effectiveness analyses performed for ACE-HIV project. Chapter 6. Thesis concludes that ACE approach could be a sound and useful approach for priority-setting in HIV medicine in Australia and that data required for the economic evaluations could be gathered from existing databases and cohorts. Introduction The research