If I recall, it was only really in the 2010s, following the release of this study (catchily named HPTN 052), that we realised that ART/​ ARV was so effective in stopping HIV transmission, so I think that was a justifiable oversight.
Assuming that prices will remain constant seems to be a genuine issue—I think we need to think about this more when we look at cost-effectiveness generally—but I have an inkling as to why this might be common.
In Mead Over’s (Justin’s colleague) excellent course on HIV and Universal Health Coverage, we modelled the cost effectiveness of ART compared to different interventions. The software package involved constant costs for ART (and second line ART) as a default setting, and didn’t assume that there would be price reductions. I didn’t ask why this was, but after adding price reductions to the model for my chosen country (Chad), I realised that the model then incentivises delaying universal ART within a country, and instead focusing on other interventions which are less likely to decrease in cost over time.
Delaying might be wise in some contexts, but I’m sure many health ministers are just looking for excuses to delay action (letting other countries bring the price down first), so politics doubtless plays a role.
Yes I wasn’t blaming economists at all, just emphasising a couple of reasons why they got it wrong. I still think its good to build in price drops into a model—when we model we should try and most accurately estimate the situation, not try and fudge it to support our position and second guess the political game.
If I recall, it was only really in the 2010s, following the release of this study (catchily named HPTN 052), that we realised that ART/​ ARV was so effective in stopping HIV transmission, so I think that was a justifiable oversight.
Assuming that prices will remain constant seems to be a genuine issue—I think we need to think about this more when we look at cost-effectiveness generally—but I have an inkling as to why this might be common.
In Mead Over’s (Justin’s colleague) excellent course on HIV and Universal Health Coverage, we modelled the cost effectiveness of ART compared to different interventions. The software package involved constant costs for ART (and second line ART) as a default setting, and didn’t assume that there would be price reductions. I didn’t ask why this was, but after adding price reductions to the model for my chosen country (Chad), I realised that the model then incentivises delaying universal ART within a country, and instead focusing on other interventions which are less likely to decrease in cost over time.
Delaying might be wise in some contexts, but I’m sure many health ministers are just looking for excuses to delay action (letting other countries bring the price down first), so politics doubtless plays a role.
Great insight Jack!
Yes I wasn’t blaming economists at all, just emphasising a couple of reasons why they got it wrong. I still think its good to build in price drops into a model—when we model we should try and most accurately estimate the situation, not try and fudge it to support our position and second guess the political game.
But perhaps that’s naive ;).