Fig. 2 Basic model of output, outcome and impact compliance of the patient is significant for the production of the outcome health out of the product health services. Finally, the impact of the outcome on a broader system is again a transformation process. For instance, a healthy population will most likely have a higher gross national product, that is, economic strength is a function of agents of production, of outputs of production, and of outcomes.
The health economic evaluation model and the COI model are closely related. The consumption of agents of production causes direct costs. Indirect costs are a monetary expression for the loss of economic wealth, that is, the impact of a health intervention is the reduction of indirect costs. The increase of health is reflected by the reduction of intangible costs.
A health economic evaluation calculates the efficiency of the transformation processes. For instance, we can compare the consumption of agents of production with the output, the outcome, or the impact of this production process. Table 1 demonstrates some possible comparisons and indicators.
The comparison between these components can be done using different methods (e.g., Murray and Evans 2003; Edejer et al. 2003; Muenning 2002; Drummond et al. 2004). First, all inputs and results can be expressed in monetary terms, that is, outputs, outcomes, and impacts are transformed to currency units and compared with the costs (difference or quotient). This cost-benefit analysis is rarely done in
Table 1 Examples for indicators of health economic evaluation
Impact: wealth, growth, etc.
Input: agents of production
Cost per admission; annual cost per HIV/AIDS-patient; Cost per prescription; profit, return on investment, cost recovery, sustainability, coverage, sales; etc.
Cost of antiviral intervention in comparison to mortality, progression, quality of life, expectancy of life); number of health care workers per life year gained
Admission of HIV/AIDS patients to hospital compared to mortality due to AIDS
Cost of antiviral intervention in comparison to increase of gross national product due to increased work force
AIDS-consultancy services compared to gross national product
Comparison of health indicators (incidence, prevalence, life expectancy, life years gained, QALYs etc.) and economic indicators (e.g. wealth, growth etc.)
the field of HIV/AIDS, as the economic value of intangible costs is very difficult to assess. Consequently, a cost-effectiveness analysis is used that compares the costs of an intervention with the direct effect, for example, increase of life expectancy. Sometimes several effects are combined to one index number (e.g., quality of life and life expectancy to a Disability Adjusted Life Year, DALY).
The following chapter will analysis a number of published studies on COI on HIV/AIDS and on antiviral intervention. For each study we analyse whether it can contribute to our understanding of the COI of AIDS and/or of the consequences of a certain intervention. As there is no literature on the socio-economic impact of resistance testing, this aspect had to be neglected. The dearth of data in this field calls for further research.
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When over eighty years of age, the poet Bryant said that he had added more than ten years to his life by taking a simple exercise while dressing in the morning. Those who knew Bryant and the facts of his life never doubted the truth of this statement.