Assessing the efficiency of mother-to-child HIV prevention in low- and middle-income countries using data envelopment analysis

A network Data Envelopment Analysis to estimate nations' efficiency in the fight against SARS-CoV-2

The ongoing outbreak of SARS-CoV-2 has been deeply impacting health systems worldwide. In this context, it is pivotal to measure the efficiency of different nations' response to the pandemic, whose insights can be used by governments and health authorities worldwide to improve their national COVID-19 strategies. Hence, we propose a network Data Envelopment Analysis (DEA) to estimate the efficiencies of fifty-five countries in the current crisis, including the thirty-seven Organisation for Economic Co-operation and Development (OECD) member countries, six OECD prospective members, four OECD key partners, and eight other countries. The network DEA model is designed as a general series structure with five single-division stages - population, contagion, triage, hospitalisation, and intensive care unit admission -, and considers an output maximisation orientation, denoting a social perspective, and an input minimisation orientation, denoting a financial perspective. It includes inputs related to health costs, desirable and undesirable intermediate products related to the use of personal protective equipment and infected population, respectively, and desirable and undesirable outputs regarding COVID-19 recoveries and deaths, respectively. To the best of the authors' knowledge, this is the first study proposing a cross-country efficiency measurement using a network DEA within the context of the COVID-19 crisis. The study concludes that Estonia, Iceland, Latvia, Luxembourg, the Netherlands, and New Zealand are the countries exhibiting higher mean system efficiencies. Their national COVID-19 strategies should be studied, adapted, and used by countries exhibiting worse performances. In addition, the observation of countries with large populations presenting worse mean efficiency scores is statistically significant.

Technical efficiency of national HIV/AIDS spending in 78 countries between 2010 and 2018: A data envelopment analysis

HIV/AIDS remains a leading global cause of disease burden, especially in low- and middle-income countries (LMICs). In 2020, more than 80% of all people living with HIV (PLHIV) lived in LMICs. While progress has been made in extending coverage of HIV/AIDS services, only 66% of all PLHIV were virally suppressed at the end of 2020. In addition to more resources, the efficiency of spending is key to accelerating progress towards global 2030 targets for HIV/AIDs, including viral load suppression. This study aims to estimate the efficiency of HIV/AIDS spending across 78 countries. We employed a data envelopment analysis (DEA) and a truncated regression to estimate the technical efficiency of 78 countries, mostly low- and middle-income, in delivering HIV/AIDS services from 2010 to 2018. Publicly available data informed the model. We considered national HIV/AIDS spending as the DEA input, and prevention of mother to child transmission (PMTCT) and antiretroviral treatment (ART) as outputs. The model was adjusted by independent variables to account for country characteristics and investigate associations with technical efficiency. On average, there has been substantial improvement in technical efficiency over time. Spending was converted into outputs almost twice as efficiently in 2018 (81.8%; 95% CI = 77.64, 85.99) compared with 2010 (47.5%; 95% CI = 43.4, 51.6). Average technical efficiency was 66.9% between 2010 and 2018, in other words 33.1% more outputs could have been produced relative to existing levels for the same amount of spending. There is also some variation between WHO/UNAIDS regions. European and Eastern and Southern Africa regions converted spending into outputs most efficiently between 2010 and 2018. Rule of Law, Gross National Income, Human Development Index, HIV prevalence and out-of-pocket expenditures were all significantly associated with efficiency scores. The technical efficiency of HIV investments has improved over time. However, there remains scope to substantially increase HIV/AIDS spending efficiency and improve progress towards 2030 global targets for HIV/AIDS. Given that many of the most efficient countries did not meet 2020 global HIV targets, our study supports the WHO call for additional investment in HIV/AIDS prevention and control to meet the 2030 HIV/AIDS and eradication of the AIDS epidemic.

Global Healthcare Resource Efficiency in the Management of COVID-19 Death and Infection Prevalence Rates

The scale of impact of the COVID-19 pandemic on society and the economy globally provides a strong incentive to thoroughly analyze the efficiency of healthcare systems in dealing with the current pandemic and to obtain lessons to prepare healthcare systems to be better prepared for future pandemics. In the absence of a proven vaccine or cure, non-pharmaceutical interventions including social distancing, testing and contact tracing, isolation, and wearing of masks are essential in the fight against the worldwide COVID-19 pandemic. We use data envelopment analysis and data compiled from Worldometers and The World Bank to analyze how efficient the use of resources were to stabilize the rate of infections and minimize death rates in the top 36 countries that represented 90% of global infections and deaths out of 220 countries as of November 11, 2020. This is the first paper to model the technical efficiency of countries in managing the COVID-19 pandemic by modeling death rates and infection rates as undesirable outputs using the approach developed by You and Yan. We find that the average efficiency of global healthcare systems in managing the pandemic is very low, with only six efficient systems out of a total of 36 under the variable returns to scale assumption. This finding suggests that, holding constant the size of their healthcare systems (because countries cannot alter the size of a healthcare system in the short run), most of the sample countries showed low levels of efficiency during this time of managing the pandemic; instead it is suspected that most countries literally "threw" resources at fighting the pandemic, thereby probably raising inefficiency through wasted resource use.

Assessing frontline HIV service provider efficiency using data envelopment analysis: a case study of Philippine social hygiene clinics (SHCs)

BACKGROUND

Globally, local and frontline HIV service delivery units have been deployed to halt the HIV epidemic. However, with the limited resources, there is a need to understand how these units can deliver their optimum outputs/outcomes efficiently given the inputs. This study aims to determine the efficiency of the social hygiene clinics (SHC) in the Philippines as well as to determine the association of the meta-predictor to the efficiencies.

METHODS

In determining efficiency, we used the variables from two data sources namely the 2012 Philippine HIV Costing study and 2011 Integrated HIV Behavioral and Serologic Surveillance, as inputs and outputs, respectively. Various data management protocols and initial assumptions in data matching, imputation and variable selection, were used to create the final dataset with 9 SHCs. We used data envelopment analysis (DEA) to analyse the efficiency, while variations in efficiencies were analysed using Tobit regression with area-specific meta-predictors.

RESULTS

There were potentially inefficient use of limited resources among sampled SHC in both aggregate and key populations. Tobit regression results indicated that income was positively associated with efficiency, while HIV prevalence was negatively associated with the efficiency variations among the SHCs.

CONCLUSIONS

We were able to determine the inefficiently performing SHCs in the Philippines. Though currently inefficient, these SHCs may adjust their inputs and outputs to become efficient in the future. While there were indications of income and HIV prevalence to be associated with the efficiency variations, the results of this case study may only be limited in generalisability, thus further studies are warranted.

Cost-Effectiveness of a Care Program for HIV/AIDS Patients Affiliated with a Health Insurer in Colombia, Comparing Three Health Care Providers Nationwide

BACKGROUND

In Colombia, HIV and AIDS constitute one of the major diseases of high cost to the health system, making necessary health risk management of patients with this disease through comprehensive health care programs with their respective evaluation of results.

OBJECTIVE

To evaluate the relative cost-effectiveness of a care program for patients with HIV/AIDS affiliated to a health insurer in Colombia, comparing their results in three Health care provider (HCP).

METHODS

The study population corresponded to a cohort of patients older than 18 years with HIV/AIDS and affiliated to a health insurer in Colombia during 2011 and 2012. A cost-effectiveness and cost-utility analysis of a health care program for this population was performed on the basis of a Markov model, in which quality-adjusted life-years (QALYs) and life-years gained were assessed. This analysis was conducted from the insurer perspective. The time horizon was life expectancy. A discount rate of 3% was applied.

RESULTS

Drugs accounted for 80.54% of care costs. The average annual cost of patients in health state 5 was 3 times higher than that of patients in state 1. HCP A compared with HCP B generated an additional 1.53 QALYs, with a rate of incremental cost-effectiveness of $2400 per QALY gained. HCP C showed a dominated behavior. The variables that most influence the uncertainty were the cost of HCP A in health state 5 (55.52%) and the cost of HCP B in state 3 (27.51%).

CONCLUSIONS

HCP A is a very cost-effective option considering a threshold of 1 time the per-capita gross domestic product.

The determinants of technical efficiency of a large scale HIV prevention project: application of the DEA double bootstrap using panel data from the Indian Avahan

BACKGROUND

In 2004, the largest HIV prevention project (Avahan) conducted globally was implemented in India. Avahan was implemented by NGOs supported by state lead partners in order to provide HIV prevention services to high-risk population groups. In 2007, most of the NGOs reached full coverage.

METHODS

Using a panel data set of the NGOs that implemented Avahan, we investigate the level of technical efficiency as well as the drivers of technical inefficiency by using the double bootstrap procedure developed by Simar & Wilson (2007). Unlike the two-stage traditional method, this method allows valid inference in the presence of measurement error and serial correlation.

RESULTS

We find that over the 4 years, Avahan NGOs could have reduced the level of inputs by 43% given the level of outputs reached. We find that efficiency of the project has increased over time. Results indicate that main drivers of inefficiency come from the characteristics of the state lead partner, the NGOs and the catchment area.

CONCLUSION

These organisational factors are important to explicitly consider and assess when designing and implementing HIV prevention programmes and in setting benchmarks in order to optimise the use and allocation of resources.

JEL CLASSIFICATIONS

C14, I1.

Controlling the HIV/AIDS epidemic: current status and global challenges

This review provides an overview of the current status of the global HIV pandemic and strategies to bring it under control. It updates numerous preventive approaches including behavioral interventions, male circumcision (MC), pre- and post-exposure prophylaxis (PREP and PEP), vaccines, and microbicides. The manuscript summarizes current anti-retroviral treatment options, their impact in the western world, and difficulties faced by emerging and resource-limited nations in providing and maintaining appropriate treatment regimens. Current clinical and pre-clinical approaches toward a cure for HIV are described, including new drug compounds that target viral reservoirs and gene therapy approaches aimed at altering susceptibility to HIV infection. Recent progress in vaccine development is summarized, including novel approaches and new discoveries.