@article{PAR00002700,
  title = {{U}niversal access to {HIV} treatment in developing countries : going beyond the misinterpretations of the 'cost-effectiveness' algorithm},
  author = {{M}oatti, {J}ean-{P}aul and {M}arlink, {R}. and {L}uchini, {S}. and {K}azatchkine, {M}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {E}conomic cost-effectiveness analysis ({CEA}) has been proposed as the appropriate tool to set priorities for resource allocation among available health interventions. {C}ontroversy remains about the way {CEA} should be used in the field of {HIV}/{AIDS}. {M}ethods and objectives: {T}his paper reviews the general literature in health economics and public economics about the use of {CEA} for priority setting in public health, in order better to inform current debates about resource allocation in the fight against {HIV}/{AIDS}. {R}esults: {T}heoretical and practical limitations of {CEA} do not raise major problems when it is applied to compare alternatives for treating the same medical condition or {P}ublic health problem. {U}sing {CEA} to set priorities among different health interventions by ranking them from the lowest to the highest {V}alues of their cost per life-year saved is appropriate {O}nly under the very restrictive and unrealistic assumptions that all interventions compared are discrete and finite alternatives that cannot vary in terms of size and scale. {I}n order for {CEA} to inform resource allocation compared across programmes to fight the {AIDS} epidemic, a pragmatic interpretation of this economic approach, like that proposed by the {C}ommission on {M}acroeconomics and {H}ealth, is better suited. {I}nterventions, like a number of preventive strategies and first-line antiretroviral treatments for {HIV}, whose marginal costs per additional life-year saved are less than three times the gross domestic product per capita, should be considered cost-effective. {C}onclusion: {B}ecause of their empirical and theoretical limitations, results of {CEA} should only be one element in priority setting among interventions for {HIV}/{AIDS}, which should also be informed by explicit debates about societal and ethical preferences.},
  keywords = {{C}ost-effectiveness ; {W}elfare economics ; {L}ow-resource settings ; {H}iv prevention ; {A}ntiretroviral treatment},
  booktitle = {},
  journal = {{A}ids},
  volume = {22},
  numero = {{S}uppl 1},
  pages = {{S}59--{S}66},
  ISSN = {0269-9370},
  year = {2008},
  DOI = {10.1097/01.aids.0000327624.69974.41},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00002700},
}