Evidence for scaling up HIV treatment in sub-Saharan Africa: A call for incorporating health system constraints.

Jan Hontelez and colleagues argue that the cost-effectiveness studies of HIV treatment scale-up need to include health system constraints to be more informative.

Incorporating equity-efficiency interactions in cost-effectiveness analysis-three approaches applied to breast cancer control.

Background: The past decade, medical technology assessment focused on cost-effectiveness analysis, yet there is an increasing need to consider equity implications of health interventions as well. This article addresses three equity-efficiency trade-off methods proposed in the literature. Moreover, it demonstrates their impact on cost-effectiveness analyses in current breast cancer control options for women of different age groups.

An eye for inequality: how trachoma relates to poverty in Tanzania and Vietnam.

Purpose: An important challenge for trachoma control strategies is to break the circle of poverty, poor hygiene and poor health by bringing its benefits to the poor. This article aims to assess to what extent trachoma is a disease of the poor, and trachoma services reach the poor in Tanzania and Vietnam.

Methods: Individual level data on trachoma prevalence (active trachoma and trichiasis) and utilization of trachoma-related services were collected in both countries in 2004.

A dollar is a dollar is a dollar--or is it?

It is normally stated that an economic evaluation should take the societal perspective and that this implies the incorporation of all costs and effects, regardless of where these occur. Nevertheless, this broad perspective may be in conflict with the narrower perspective of the health-care decision-makers we are usually trying to aid. In this article, it is argued that not all costs have to be considered equally important for health-care decision-making and that there is a discrepancy between the economically preferred societal perspective and the aim of aiding health-care decision-makers.

Cost-effectiveness of trachoma control in seven world regions.

Background/aims: The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and antibiotics in trachoma-endemic areas in seven world regions.

Methods: A population model was applied to follow the lifelong impact on individuals receiving trachoma control.

Uncertainty in cost-effectiveness analysis. Probabilistic uncertainty analysis and stochastic league tables.

Interest is growing in the application of standard statistical inferential techniques to the calculation of cost-effectiveness ratios (CER), but individual level data will not be available in many cases because it is very difficult to undertake prospective controlled trials of many public health interventions. We propose the application of probabilistic uncertainty analysis using Monte Carlo simulations, in combination with nonparametric bootstrapping techniques where appropriate. This paper also discusses how decision makers should interpret the CER of interventions where uncertainty intervals overlap.