Economic analysis of HIV prevention and treatment portfolios
- Jessie Lue Juusola.
- June 2012.
- Physical description
- online resource (xiii, 142 pages) : illustrations (some color)
- Juusola, Jessie Lue.
- Bendavid, Eran. thesis advisor.
- Brandeau, Margaret L. thesis advisor (primary).
- Owens, Douglas K. thesis advisor.
- Stanford University. Department of Management Science and Engineering.
- Stanford University. Committee on Graduate Studies. degree grantor.
- Includes bibliographical references (p. 132-142). 146 refs.
- Human immunodeficiency virus (HIV) is a significant problem worldwide as well as in the United States (US), despite ongoing efforts to limit HIV transmission. In the US, men who have sex with men (MSM) account for over half of new HIV infections every year, and thus are an important group to consider for HIV interventions. Both prevention and treatment options are available to combat HIV transmission, but decision makers must prioritize among the available disease control strategies. Mathematical modeling frameworks can be used to assess the value and efficiency of various disease control measures and help inform resource allocation decisions. This dissertation describes research on economic analysis of HIV prevention and treatment portfolios, primarily for MSM in the US. We develop two independent mathematical modeling frameworks, both intended to assist decision makers with minimizing HIV transmission in the most cost-effective manner. First, in Chapter 2, we present a dynamic compartmental model of the HIV epidemic that we built and instantiated for MSM in the US. This model can be used to assess the effectiveness and cost-effectiveness of prevention and treatment programs for MSM. In particular, in Chapter 3 we examine testing for and treating acute HIV infection, and in Chapter 4 we examine preexposure prophylaxis for HIV prevention. We find that symptom-based testing for acute HIV infection is cost-effective for MSM in the US, but incorporating testing for acute infection into the standard HIV screening protocol is not. For preexposure prophylaxis, we find that it is not cost-effective for the general MSM population, but it provides good value in high-risk MSM. In Chapter 5, we present a resource allocation framework for determining the optimal mix of HIV treatment and prevention programs, given a fixed budget. We develop methods of linearly estimating health benefits and costs that account for epidemic effects of reducing disease transmission. We illustrate our model with the examples of preexposure prophylaxis and community-based education compared with antiretroviral therapy for MSM in the US. We show both analytically and with the examples that HIV budgets are often best spent on the program that offers the greatest "bang for the buck.".
- Publication date
- Submitted to the Department of Management Science and Engineering and the Committee on Graduate Studies of Stanford University.
- Thesis (Ph.D.)--Stanford University, 2012.