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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.