Chapter 42: Conclusions I: How Not to Set Priorities for HIV
It is time to sum up what CBA has to offer in the setting of priorities for interventions to deal with HIV/AIDS. In this chapter we look at three main ways that priorities are set in practice that do not rely on CBA methods. We see that all sorts of mistakes, and hence a large waste of resources, follow from ignoring CBA. Then in the next, and final, chapter we show how many concerns that people have, which are thought to be essential in setting priorities, are indeed included in CBA automatically. 1. EVALUATING BY LABELING In the HIV/AIDS field, many judgments are made about projects just by looking at the label associated with the intervention. Here we look at some of the main labels and explain why they are not helpful. (i) “Prevention” is Better than Cure A British saying is that “A penny’s worth of prevention is worth a pound’s worth of cure”. How can this not be true for HIV/AIDS interventions? There are two main surveys of a large number of HIV/AIDS evaluations by Creese et al. (2002) and Canning (2006). These surveys show clearly that treatment cost-effectiveness ratios are so much lower (we get so many more DALYs per dollar of expenditure) for prevention programs (such as condoms, blood safety, education and information) than for treatment projects (such as investing in ARVs). Surely, prevention is the way to go? Not necessarily. Here are some reservations: ● Even if every prevention program were more cost-effective than every treatment...
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