Modeling the Cost-effectiveness of HIV/AIDS Interventions in Different Socio-economic Contexts in South Africa (2007-2020)

Evidence of how cost-effectiveness (CE) of an HIV/AIDS intervention compares in a rural context and an urban context is deficient yet crucial to potential efficiency in resource allocations in South Africa. To inform policy makers about such potential, the CE of major HIV/AIDS interventions is estimated in these contexts over the period 2007-2020. Two versions of Spectrum Policy Modeling System (SPMS) are constructed; one for a rural context and another for an urban context. Then each version is populated with context-specific parameters, before being used to project the annual number of patients and health outcomes of an HIV/AIDS intervention and a related USUAL CARE. The cost evidence for an HIV/AIDS intervention and related USUAL CARE is applied to projected number of patients and the incremental CE ratio (ICER) of an HIV/AIDS intervention relative to USUAL CARE in each context is estimated. The ICERs in the two contexts for the same HIV/AIDS intervention are then used to compare the CE of that HIV/AIDS intervention across contexts. The paper finds that CE estimates of an HIV/AIDS intervention across a rural context and an urban context differ and the extent of that difference varies across HIV/AIDS interventions. Therefore, policy makers can increase efficiency by allocating resources in HIV/AIDS interventions in socio-economic contexts according to CE variations in such contexts.