Division of Medical Statistics, Graduate School of Medicine, Kobe University, Japan.
J Med Econ. 2011;14(2):187-93. doi: 10.3111/13696998.2011.557111. Epub 2011 Feb 18.
To investigate how the cost effectiveness of preventing HIV/AIDS varies across possible efficiency frontiers (EFs) by taking into account potentially relevant external factors, such as prevention stage, and how the EFs can be characterized using regression analysis given uncertainty of the QALY-cost estimates.
We reviewed cost-effectiveness estimates for the prevention and treatment of HIV/AIDS published from 2002-2007 and catalogued in the Tufts Medical Center Cost-Effectiveness Analysis (CEA) Registry. We constructed efficiency frontier (EF) curves by plotting QALYs against costs, using methods used by the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany. We stratified the QALY-cost ratios by prevention stage, country of study, and payer perspective, and estimated EF equations using log and square-root models.
A total of 53 QALY-cost ratios were identified for HIV/AIDS in the Tufts CEA Registry. Plotted ratios stratified by prevention stage were visually grouped into a cluster consisting of primary/secondary prevention measures and a cluster consisting of tertiary measures. Correlation coefficients for each cluster were statistically significant. For each cluster, we derived two EF equations - one based on the log model, and one based on the square-root model.
Our findings indicate that stratification of HIV/AIDS interventions by prevention stage can yield distinct EFs, and that the correlation and regression analyses are useful for parametrically characterizing EF equations. Our study has certain limitations, such as the small number of included articles and the potential for study populations to be non-representative of countries of interest. Nonetheless, our approach could help develop a deeper appreciation of cost effectiveness beyond the deterministic approach developed by IQWiG.
通过考虑潜在相关的外部因素（如预防阶段），研究在可能的效率前沿（EF）下，预防 HIV/AIDS 的成本效益如何因不同情况而变化，并探讨如何在 QALY-成本估计不确定的情况下，利用回归分析来描述 EF。
我们回顾了 2002-2007 年期间发表的 Tufts 医疗中心成本效益分析（CEA）注册中心中预防和治疗 HIV/AIDS 的成本效益估计，并对其进行了分类。我们通过使用德国卫生保健质量和效率研究所（IQWiG）的方法，绘制 QALY 与成本的效率前沿（EF）曲线。我们按预防阶段、研究国家和支付者视角对 QALY-成本比进行分层，并使用对数和平方根模型估计 EF 方程。
Tufts CEA 注册中心共确定了 53 个 HIV/AIDS 的 QALY-成本比。按预防阶段分层的比值图在视觉上分为由初级/二级预防措施组成的一组和由三级措施组成的一组。每组的相关系数均具有统计学意义。对于每个聚类，我们推导出两个 EF 方程 - 一个基于对数模型，另一个基于平方根模型。
我们的发现表明，按预防阶段分层的 HIV/AIDS 干预措施可以产生不同的 EF，并且相关和回归分析对于参数化描述 EF 方程是有用的。我们的研究存在一定的局限性，例如纳入的文章数量较少，以及研究人群可能无法代表感兴趣的国家。尽管如此，我们的方法可以帮助深入了解成本效益，超越 IQWiG 开发的确定性方法。
