The Potential Cost-Effectiveness of HIV Vaccines: A Systematic Review

Adamson, Blythe; Dimitrov, Dobromir; Devine, Beth; Barnabas, Ruanne V.

doi:10.1007/s41669-016-0009-9

“…The capital cost accounted for just about one-sixth of the total cost of care 8 26 27 . However, there is a significant variation in capital cost among different hospitals, ranging from 3.4 to 29.3 million, which is associated with scale of operation.…”

Section: Discussionmentioning

confidence: 99%

Cost of delivering secondary-level health care services through public sector district hospitals in India

Prinja

¹

,

Balasubramanian

²

,

Jeet

³

et al. 2017

Indian Journal of Medical Research

17

0

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Background & objectives: Despite an impetus for strengthening public sector district hospitals for provision of secondary health care in India, there is lack of robust evidence on cost of services provided through these district hospitals. In this study, an attempt was made to determine the unit cost of an outpatient visit consultation, inpatient bed-day of hospitalization, surgical procedure and overall per-capita cost of providing secondary care through district hospitals. Methods: Economic costing of five randomly selected district hospitals in two north Indian States - Haryana and Punjab, was undertaken. Cost analysis was done using a health system perspective and employing bottom-up costing methodology. Quantity of all resources - capital or recurrent, used for delivering services was measured and valued. Median unit costs were estimated along with their 95 per cent confidence intervals. Sensitivity analysis was undertaken to assess the effect of uncertainties in prices and other assumptions; and to generalize the findings for Indian set-up. Results: The overall annual cost of delivering secondary-level health care services through a public sector district hospital in north India was JOURNAL/ijmer/04.03/02223309-201746030-00010/math_10MM1/v/2022-09-30T185254Z/r/image-tiff 11,44,13,282 [US Dollars (USD) 2,103,185]. Human resources accounted for 53 per cent of the overall cost. The unit cost of an inpatient bed-day, surgical procedure and outpatient consultation was JOURNAL/ijmer/04.03/02223309-201746030-00010/math_10MM2/v/2022-09-30T185254Z/r/image-tiff 844 (USD 15.5), i; 3481 (USD 64) and JOURNAL/ijmer/04.03/02223309-201746030-00010/math_10MM3/v/2022-09-30T185254Z/r/image-tiff 170 (USD 3.1), respectively. With the current set of resource allocation, per-capita cost of providing health care through district hospitals in north India was JOURNAL/ijmer/04.03/02223309-201746030-00010/math_10MM4/v/2022-09-30T185254Z/r/image-tiff 139 (USD 2.5). Interpretation & conclusions: The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India.

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“…Considerable effort has been expended in trying to stimulate the immune system to counter HIV by using vaccines [30]. A far more reasonable approach is to enhance the ACE pathway.…”

Section: The Ace Pathway Versus the Immune System In Combatting Infecmentioning

confidence: 99%

The Many Biological Functions of the Alternative Cellular Energy (ACE) Pathway

Martin¹

2017

IJCAM

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This article summarizes the known biological functions of the alternative cellular energy (ACE) pathway. It has been proposed that this pathway is powered by a natural force called KELEA (kinetic energy limiting electrostatic attraction). KELEA can be transferred to liquids, including water and body fluids. The absorption of KELEA results in a loosening and possible lengthening of the intermolecular bonding between the liquid molecules, along with an increase in the kinetic activity of the molecules. KELEA can also provide an energy source for biosynthetic chemical reactions, including the synthesis of lipids. Since many human illnesses are attributed to insufficienct cellular energy (ICE), procedures aimed at enhancing the ACE pathway are likely to be therapeutically useful. Some of these procedures are currently available for widespread clinical use once they receive regulatory approval. A consortium of interacting clinicians is envisioned to assist in optimizing the current procedures for enhancing the ACE pathway and to develop new approaches. Patient support groups can also assist in the evaluation of various self-directed therapeutic procedures. Collectively, these efforts should significantly decrease the existing costs of medical care and provide effective therapies for several major illnesses for which none presently exists. Keywords: IntroductionIt has been assumed that the cellular energy utilized by animals and humans is solely obtained from the Calories available in consumed food. Yet, the work output of a typical human in terms of the functioning of different organ systems, muscular activities and maintaining body temperature are not explainable by the input of dietary calories [1,2]. To put this issue into perspective, the maximum available energy upon consumption of a diet of 2,000 Calories is less than that in a tenth of a gallon of gasoline (8.4 million versus 13 million joules). A Calorie (kilocalorie) is 4,200 joules and is defined as the heat necessary to raise the temperature of a kilogram (Kg) of water by 1 o Centigrade (C). Over a 24-hour period, an individual weighing 75 kilograms and assumed to be composed essentially of water, requires 6.3 million joules (1,500 Calories) to maintain a body temperature of 37 °C if living in an environment with an average temperature of 17 °C (59 o Fahrenheit).[75 x (37-17) = 1,500]. Estimates of the work output of various organs within the body, such as the heart and brain, are generally based on oxygen consumption, which again incorrectly assumes that food metabolism is the sole source of cellular energy. Higher estimates of work output are obtained using measures of biosynthesis, fluid movements, muscular performance, electrical activity, etc. It is reasonable, therefore, to consider that there is a mechanism, other than consuming food, by which the body can acquire cellular energy. Beliefs in Non-Conventional EnergiesTraditional Oriental Medicine providers and Complementary Medicine (CAM) practitioners have long maintained that the body expr...

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“…Such vaccine could be seen as a first-generation product that must still be improved upon in order to fundamentally transform the HIV epidemic. Mathematical models [23,19,39,6,18,26,25,16,31,5,24] suggest that the first-generation vaccine would be useful and cost-effective to roll out, but that its overall impact will be modest. Here, we explore what factors contribute collectively to limiting the impact of such a vaccine.…”

Section: Introductionmentioning

confidence: 99%

The future of a partially effective HIV vaccine: assessing limitations at the population level

Selinger

¹

,

Dimitrov

²

,

Welkhoff

³

et al. 2019

Preprint

0

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ObjectivesMathematical models have unanimously predicted that a first-generation HIV vaccine would be useful and cost-effective to roll out, but that its overall impact would be insufficient to reverse the epidemic. Here, we explore what factors contribute most to limiting the impact of such a vaccine. MethodsRanging from a theoretical ideal to a more realistic regimen, mirroring the one used in the currently ongoing trial in South Africa (HVTN 702), we model a nested hierarchy of vaccine attributes such as speed of roll-out, efficacy, and retention of booster doses. ResultsThe predominant reasons leading to a substantial loss of vaccine impact on the HIV epidemic are the time required to scale up mass vaccination, limited durability and waning of efficacy. Conclusions A partially effective HIV vaccine will be a critical milestone for the development of a highly effective, durable, and scalable next-generation vaccine. Accelerated development, expedited vaccine availability, and improved immunogenicity are the main attributes of a vaccine that could dramatically reverse the course of the epidemic in highly endemic countries.

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The Potential Cost-Effectiveness of HIV Vaccines: A Systematic Review

Cited by 22 publications

References 37 publications

Cost of delivering secondary-level health care services through public sector district hospitals in India

Cost of delivering secondary-level health care services through public sector district hospitals in India

The Many Biological Functions of the Alternative Cellular Energy (ACE) Pathway

The future of a partially effective HIV vaccine: assessing limitations at the population level

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