Skip to main content
SpringerLink
Log in

Resource Allocation and the Funding of HIV Prevention

  • Chapter
Handbook of Economic Evaluation of HIV Prevention Programs

Part of the book series: AIDS Prevention and Mental Health ((APMH))

Abstract

Issues of priority setting in the health sector force decision makers to confront a tangled web of competing obligations. Confronted with limited resources and a seemingly infinite array of attractive programs, decision makers face a constant struggle to balance their ethical duty to do what is best for the individual against their responsibility to use society’s resources to promote the collective safety and well-being efficiently and fairly. In HIV prevention, these painful trade-offs are further complicated by the fact that they must be made against the backdrop of a tragic epidemic, contentious political and social debate, aggressive community activism, and limited information regarding the costs and consequences of intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Holtgrave DR, Qualls NL, and Graham JD. Economic evaluation of HIV prevention programs. Annu Rev Public Health 1996; 17: 467–488.

    Article  PubMed  CAS  Google Scholar 

  2. Elixhauser A, Luce BR, Taylor R, Reblando J. Health care CBA/CEA: An update on the growth and composition of the literature. Medical Care 1989; 27: S190-S204.

    Google Scholar 

  3. Tengs TO, Adams ME, Pliskin JS, Safran DG, Siegel JE, Weinstein MC, Graham JD. Five hundred life-saving interventions and their cost-effectiveness. Risk Analysis 1995; 15: 369–390.

    Article  PubMed  CAS  Google Scholar 

  4. Zeckhauser R. Procedures for valuing lives. Public Policy 1975; 23: 419–464.

    PubMed  CAS  Google Scholar 

  5. Zeckhauser R, Shepard D. Where now for saving lives? Law and Contemporary Problems 1976; 40: 5–45.

    Article  Google Scholar 

  6. Bailey MJ. Reducing Risks to Life: Measurement of the Benefits. Washington, DC American Enterprise Institute; 1980.

    Google Scholar 

  7. Lave LB. The Strategy of Social Regulation. Washington, DC Brookings Institution; 1981.

    Google Scholar 

  8. Slovic P. Perception of risk. Science 1987; 36: 280–285.

    Article  Google Scholar 

  9. Fischhoff B, Slovic P, Lichtenstein S, Read S, Combs B. How safe is safe enough? A psychometric study of attitudes towards risks and benefits. Policy Sci 1978; 9: 127–152.

    Article  Google Scholar 

  10. Torrance GW, Thomas WH, Sackett DL. A utility maximization model for evaluation of health care programs. Health Serv Res 1972; 7: 118–133.

    PubMed  CAS  Google Scholar 

  11. Weinstein MC, Zeckhauser R. Critical ratios and efficient allocation. J Public Econ 1973; 2: 147–157.

    Article  Google Scholar 

  12. Weinstein MC. Principles of cost-effective resource allocation in health care organizations. Int J Technol Assessment Health Care 1990; 6: 93–103.

    Article  CAS  Google Scholar 

  13. Johannesson M, Weinstein MC. On the decision rules of cost-effectiveness analysis. J. Health Econ 1993; 12: 459–467.

    Article  PubMed  CAS  Google Scholar 

  14. Birch S, Gafni A. Cost effectiveness analyses: Do current decision rules lead us where we want to be? J Health Econ 1992; 11: 279–296.

    Article  PubMed  CAS  Google Scholar 

  15. Stinnett AA, Paltiel AD. Mathematical programming for the efficient allocation of health care resources. J Health Econ 1996; 15: 641–653.

    Article  PubMed  CAS  Google Scholar 

  16. U.S. Department of Health and Human Services and the Foundation for Health Services Research. The Comparative Benefits Modeling Project. A Framework for Cost-Utility Analysis of Government Health Care Programs. A report to the Office of Disease Prevention and Health Promotion, Public Health Service; 1992; pp. 15-17.

    Google Scholar 

  17. Weinstein MC. Tutorial: Economic assessments of medical practices and technologies. Medical Decision Making 1981; 1: 309–330.

    Article  PubMed  CAS  Google Scholar 

  18. Klevit HD, Bates AC, Castanares T, et al. Prioritization of health care services: A progress report by the Oregon Health Services Commission. Arch Intern Med 1991; 151: 912–916.

    Article  PubMed  CAS  Google Scholar 

  19. Drummond MF. Basing prescription drug payment on economic analysis: The case of Australia. Health Aff Winter, 1992; 191-196.

    Google Scholar 

  20. Bloom BS. Issues in mandatory economic assessment of Pharmaceuticals. Health Aff Winter, 1992; 197-201.

    Google Scholar 

  21. Freund DA, Evans D, Henry D, Dittus R. Implications of the Australian guidelines for the United States. Health Aff Winter 1992; 202-206.

    Google Scholar 

  22. Birch S, Gafni A. Changing the problem to fit the solution: Johannesson and Weinstein’s (mis) application of economics to real world problems. J Health Econ 1993; 12: 469–476.

    Article  PubMed  CAS  Google Scholar 

  23. Keeney RL, Raiffa H. Decisions with Multiple Objectives: Preferences and Value Trade-Offs. New York Wiley; 1976.

    Google Scholar 

  24. Garber AM, Phelps CE. Economic foundations of cost-effectiveness analysis. Working paper #4164, Cambridge, MA National Bureau of Economic Research; 1992.

    Google Scholar 

  25. Torrance GW. Utility approach to measuring health related quality of life. J Health Econ 1986; 5: 1–30.

    Article  PubMed  CAS  Google Scholar 

  26. Kaplan RM. Utility assessment for estimating quality-adjusted life-years. In FA Sloan, ed. Valuing Health Care: Costs, Benefits, and the Effectiveness of Pharmaceuticals and Other Medical Technologies. New York Cambridge University Press; 1995.

    Google Scholar 

  27. Patrick DL, Erickson P. Health Status and Health Policy: Quality of Life in Health Care Evaluation and Resource Allocation. New York Oxford University Press; 1993.

    Google Scholar 

  28. Paltiel AD, Stinnett AA. AIDS. In B Spilker, ed. Quality of Life and Pharmacoeconomics in Clinical Trials, 2nd ed. New York: Raven Press; 1996.

    Google Scholar 

  29. Wu AW, Rubin HR. Measuring health status and quality of life in HIV and AIDS. Psychol Health 1992; 6: 251–264.

    Article  Google Scholar 

  30. Owens DK, Sox HC. Medical decision making: Probabilistic medical reasoning. In Shortliffe EH, Perreault LE, Fagan LM, Wiederhold G, eds. Medical Informatics: Computer Applications in Medicine. Reading, MA: Addison-Wesley; 1990; 70–116.

    Google Scholar 

  31. Tsevat J. Methods for assessing health-related quality of life in HIV-infected patients. Psychol Health 1994; 9:19–30.

    Article  Google Scholar 

  32. Gelber RD, Lenderking WR, Cotton DJ, et al. Quality-of-life evaluation in a clinical trial of zidovudine therapy in patients with mildly symptomatic HIV infection. Ann Intern Med 1992; 116:961–966.

    Article  PubMed  CAS  Google Scholar 

  33. Wu AW, Lamping DL. Assessment of quality of life in HIV disease. AIDS 1994; 8:S349–S359.

    Google Scholar 

  34. Phelps CE, Mushlin AI. On the near equivalence of cost-effectiveness and cost-benefit analysis. Int J Technol Assessment Health Care 1991; 7:12–21.

    Article  CAS  Google Scholar 

  35. Pauly MV. Valuing health care benefits in money terms, in FA Sloan, ed. Valuing Health Care: Costs, Benefits, and the Effectiveness of Pharmaceuticals and Other Medical Technologies. New York Cambridge University Press; 1995.

    Google Scholar 

  36. Bulgin RH. Comparative costs of various dialysis treatments. Peritoneal Dialysis Bull 1981; 1: 88–91.

    Google Scholar 

  37. Ludbrook A. A cost-effectiveness analysis of the treatment of chronic renal failure. Appl Econ 1981; 13: 337–350.

    Article  Google Scholar 

  38. Churchill DN, Lemon BC, Torrance GW. A cost-effectiveness analysis of continuous ambulatory peritoneal dialysis and hospital hemodialysis. Medical Decision Making 1984; 4: 489–500.

    Article  Google Scholar 

  39. Bryers E, Hawthorne J. Screening for mild hypertension: Costs and benefits. J Epidemiol Community Health 1978; 32: 171–174.

    Article  PubMed  CAS  Google Scholar 

  40. Torrance GW. Measurement of health state utilities for economic appraisal: A review. J Health Econ 1986; 5: 1–30.

    Article  PubMed  CAS  Google Scholar 

  41. Drummond MF, Torrance GW, Mason J. Cost-effectiveness league tables: More harm than good? Soc Sci Med 1993; 37: 33–40.

    Article  PubMed  CAS  Google Scholar 

  42. Mason J, Drummond MF, Torrance GW. Some guidelines on the use of cost-effectiveness league tables. Br Med J 1993; 306: 570–572.

    Article  CAS  Google Scholar 

  43. Owens DK, Nease RF, Harris RA. Use of cost-effectiveness and value of information analyses to customize guidelines for specific clinical practice settings. Medical Decision Making 1993; 13: 395 (Abstract).

    Google Scholar 

  44. Holtgrave DR, Quails NL. Threshold analysis and programs for HIV prevention. Medical Decision Making 1995; 15: 311–317.

    Article  PubMed  CAS  Google Scholar 

  45. Kaplan RM, Bush JW. Health-related quality of life measurement for evaluation research and policy analysis. Health Psychol 1981; 1: 61–80.

    Article  Google Scholar 

  46. Laupacis A, Feeny D, Deetsky A, Tugwell PX. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. J Can Medical Assoc 1992; 146: 473–481.

    CAS  Google Scholar 

  47. Weinstein MC. From cost-effectiveness ratios to resource allocation: Where to draw the line? In FA Sloan, ed. Valuing Health Care: Costs, Benefits, and the Effectiveness of Pharmaceuticals and Other Medical Technologies. New York Cambridge University Press; 1995.

    Google Scholar 

  48. Schwing R. Longevity benefits and costs of reducing various risks. Technol Forecasting Soc Change 1979; 13: 333–345.

    Article  CAS  Google Scholar 

  49. Graham JD, Vaupel J. Value of a life: What difference does it make? Risk Anal 1981; 1: 89–95.

    Article  Google Scholar 

  50. Van Houtven G, Cropper ML. When is a life too costly to save: Evidence from US environmental regulations. World Bank Policy Research Paper No. 1260; 1994.

    Google Scholar 

  51. Graham JD. How to save 60,000 lives. Electric Perspect 1995; 20: 14–21.

    Google Scholar 

  52. Tengs TO. The opportunity costs of haphazard societal investments in life-saving. Optimizing societal investments in the prevention of premature death. Unpublished doctoral dissertation, Harvard University; 1994.

    Google Scholar 

  53. Wilkerson I. Prenuptial AIDS screening a strain in Illinois. New York Times January 26, 1988; p 1.

    Google Scholar 

  54. Illinois may end premarital AIDS testing. New York Times January 23, 1989; p 10.

    Google Scholar 

  55. Belongia EA, Vergeront JM, Davis JP. Border hopping as a consequence of premarital HIV screening: The Kenosha diamond (letter). JAMA 1988; 260: 1883–1884.

    Article  PubMed  CAS  Google Scholar 

  56. Tengs TO, Meyer G, Siegel JE, Pliskin JS, Graham JD, Weinstein MC. Oregon’s Medicaid ranking and cost-effectiveness: Is there any relationship? Medical Decision Making 1996; 16: 99–107.

    Article  PubMed  CAS  Google Scholar 

  57. Hadorn DC. Setting health care priorities in Oregon: Cost-effectiveness meets the rule of rescue. JAMA 1991; 265: 2218–2225.

    Article  PubMed  CAS  Google Scholar 

  58. Eddy DM. Oregon’s methods: Did cost-effectiveness analysis fail? JAMA 1991; 266: 2135–2141.

    Article  PubMed  CAS  Google Scholar 

  59. Hadorn D. The Oregon priority-setting exercise: Cost-effectiveness and the rule of rescue, revisited. Medical Decision Making 1996; 17: 117–119.

    Article  Google Scholar 

  60. Slovik P, Fischhoff B, Lichtenstein S. Characterizing perceived risk. In Kates RW, Hohenemser C, Kasperson JX, eds. Perilous Progress: Managing the Hazards of Technology. Boulder, CO Westview Press; 1985.

    Google Scholar 

  61. Douglas M. Risk Acceptability According to the Social Sciences. New York Russell Sage Foundation; 1985.

    Google Scholar 

  62. Freedland J. Life could be in good Carolina. The Observer. May 5, 1996; p 21.

    Google Scholar 

  63. Goodstein L. Crying foul over Mantle; liver transplant sparks ethics, alcoholism debate. The Washington Post. June 10, 1995; p. B01.

    Google Scholar 

  64. Pious S. The Psychology of Judgment and Decision Making. New York McGraw-Hill; 1993.

    Google Scholar 

  65. Manning WG, Keeler EB, Newhouse JP, et al. The Cost of Poor Health Habits. Harvard University Press Cambridge, MA; 1991.

    Google Scholar 

  66. Viscusi WK. Cigarette taxation and the social consequences of smoking. NBER Working Paper No. 4891. Cambridge, MA National Bureau of Economic Research; 1994.

    Google Scholar 

  67. Schelling TC. The Life You Save May Be Your Own. In Chase SC, ed. Problems in Public Expenditure Analysis. Washington DC Brookings Institution; 1968.

    Google Scholar 

  68. Jonsen A. Bentham in a box: Technology assessment and health care allocation. Law Med Health Care 1986; 14: 172–174.

    PubMed  CAS  Google Scholar 

  69. Raiffa H, Schwartz WB, Weinstein MC. Evaluating health effects of societal decisions and programs. In Decision Making in the Environmental Protection Agency. Selected Working Papers, Washington, DC: National Academy of Science; 1977.

    Google Scholar 

  70. Ames B, Gold LS. Chemical Carcinogenesis: Too many rodent carcinogens. Proc Nat Acad Sci USA 1990; 87: 7782–7786.

    Article  PubMed  CAS  Google Scholar 

  71. Brett AS. Hidden ethical issues in clinical decision analysis. N Engl J Med 1981; 305: 1150–1152.

    Article  PubMed  CAS  Google Scholar 

  72. Paltiel AD, Stinnett AA. Making health policy decisions: Is human instinct rational? Is rational choice human? Chance 1996; 9: 34–39.

    Google Scholar 

  73. Eddy DM. The individual vs. society: Resolving the conflict. JAMA 1991; 265: 2399–2406.

    Article  PubMed  CAS  Google Scholar 

  74. Etzioni A. Normative-affective factors: Toward a new decision making model. J Econ Psychol 1988; 9: 125–150.

    Article  Google Scholar 

  75. Bell DE, Raiffa H, Tversky A, eds. Decision Making: Descriptive, Normative, and Prescriptive Interactions. Cambridge Cambridge University Press; 1988.

    Google Scholar 

  76. Kasperson RE, Kasperson JX. The social amplification and attenuation of risk. Ann Am Acad Political Soc Sci 1996; 545: 95–105.

    Article  Google Scholar 

  77. Phillips KA, Rosenblatt A. Speaking in tongues: Integrating economics and psychology into health and mental health services outcomes research. Medical Care Rev Summer, 1992; 49: 191–231.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Medicine, Yale University, New Haven, Connecticut, 06520, USA

    A. David Paltiel

  2. Department of Health Care Organization and Policy, University of Alabama, Birmingham, Alabama, 35294, USA

    Aaron A. Stinnett

Authors
  1. A. David Paltiel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aaron A. Stinnett
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, 53202, USA

    David R. Holtgrave Ph.D.

Rights and permissions

Reprints and permissions

Copyright information

© 1998 Springer Science+Business Media New York

About this chapter

Cite this chapter

Paltiel, A.D., Stinnett, A.A. (1998). Resource Allocation and the Funding of HIV Prevention. In: Holtgrave, D.R. (eds) Handbook of Economic Evaluation of HIV Prevention Programs. AIDS Prevention and Mental Health. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1878-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4899-1878-9_10

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4899-1880-2

  • Online ISBN: 978-1-4899-1878-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation