Zaric G S, Brandeau M L
Ivey School of Business, University of Western Ontario, London, Canada.
Med Decis Making. 2001 Sep-Oct;21(5):391-408. doi: 10.1177/0272989X0102100506.
In this article, the authors determine the optimal allocation of HIV prevention funds and investigate the impact of different allocation methods on health outcomes.
The authors present a resource allocation model that can be used to determine the allocation of HIV prevention funds that maximizes quality-adjusted life years (or life years) gained or HIV infections averted in a population over a specified time horizon. They apply the model to determine the allocation of a limited budget among 3 types of HIV prevention programs in a population of injection drug users and nonusers: needle exchange programs, methadone maintenance treatment, and condom availability programs. For each prevention program, the authors estimate a production function that relates the amount invested to the associated change in risky behavior.
The authors determine the optimal allocation of funds for both objective functions for a high-prevalence population and a low-prevalence population. They also consider the allocation of funds under several common rules of thumb that are used to allocate HIV prevention resources. It is shown that simpler allocation methods (e.g., allocation based on HIV incidence or notions of equity among population groups) may lead to alloctions that do not yield the maximum health benefit.
The optimal allocation of HIV prevention funds in a population depends on HIV prevalence and incidence, the objective function, the production functions for the prevention programs, and other factors. Consideration of cost, equity, and social and political norms may be important when allocating HIV prevention funds. The model presented in this article can help decision makers determine the health consequences of different allocations of funds.
在本文中，作者确定了艾滋病病毒预防资金的最优分配方式，并研究了不同分配方法对健康结果的影响。
作者提出了一种资源分配模型，该模型可用于确定艾滋病病毒预防资金的分配，以在特定时间范围内使人群中获得的质量调整生命年（或生命年）最大化，或避免的艾滋病病毒感染最大化。他们应用该模型来确定在注射吸毒者和非注射吸毒者人群中，在三种艾滋病病毒预防项目之间分配有限预算：针头交换项目、美沙酮维持治疗和避孕套供应项目。对于每个预防项目，作者估计了一个生产函数，该函数将投入的资金量与危险行为的相关变化联系起来。
作者确定了高流行率人群和低流行率人群在两个目标函数下的最优资金分配。他们还考虑了在用于分配艾滋病病毒预防资源的几种常见经验法则下的资金分配。结果表明，更简单的分配方法（例如，基于艾滋病病毒发病率或人群组间公平概念的分配）可能导致无法产生最大健康效益的分配。
人群中艾滋病病毒预防资金的最优分配取决于艾滋病病毒的流行率和发病率、目标函数、预防项目的生产函数以及其他因素。在分配艾滋病病毒预防资金时，考虑成本、公平性以及社会和政治规范可能很重要。本文提出的模型可以帮助决策者确定不同资金分配的健康后果。
