Allocating HIV-prevention resources: balancing efficiency and equity.
The primary goal of HIV prevention is to prevent as many infections as possible. This requires allocating HIV-prevention resources according to cost effectiveness principles: those activities that prevent more infections per dollar are favored over those that prevent fewer. This is not current practice in the United States, where prevention resources from the federal government to the states flow in proportion to reported AIDS cases. Although such allocations might be considered equitable, more infections could be prevented for the same expenditures were cost-effectiveness principles invoked. The downside of pure cost-effective allocations is that they violate common norms of equity. In this article, we argue for a middle ground that promotes both equity and efficiency in allocating federal HIV-prevention resources.
Kaplan
Edward H
EH
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn 06520, USA. edward.kaplan@yale.edu
Merson
Michael H
MH
D000163:Acquired Immunodeficiency Syndrome / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D005380:Financing, Government; D015658:HIV Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D015276:Health Care Rationing / Q000191:economics* / Q000379:methods; D006302:Health Services Research; D006801:Humans; D017063:Outcome Assessment, Health Care; D011322:Primary Prevention / Q000191:economics* / Q000592:standards; D040841:Resource Allocation / Q000191:economics*; D014481:United States / Q000453:epidemiology