1. Kalipso Chalkidou, MD, PhD
HIV Treatment and Value for Money: can we afford to ignore opportunity costs?
 A more effective response to HIV/AIDS: the role of Value for Money
Paris, July 2017
Kalipso Chalkidou, MD, PhD
Professor of Global Health Practice, Imperial College London
Director, international Decision Support Initiative
Trade offs are made
…would a “1st world” model address the needs of people living in poorer countries given the resource constraints and available techs? – take Viral Load and more sensitive/earlier treatment thresholds; spent on diagnostics and on comorbidities? Second line ARVs
Health Affairs – 2009 data – 18% of spend on 5% of population on second line ARVs (Soni, Health Affairs, 2009)

2. More money, less health… Healthcare budgets often underspent
“For every US$100 that goes into state coffers in Africa, on average US$16 is allocated to health, only US$10 is in effect spent, and less than US$4 goes to the right health services.”
More money,
less health…
Healthcare budgets often underspent
More than money
20-40% of the $7.1 trillion spent every year on health is wasted – WDR 2010; corroborated by OECD report in Jan 2017 (~30%)
LICs incl fragile states rely on less than a quarter of their THE on foreign sources (WHO source – May 2017)
Issues with absorbability, unfair distribution (poorest most likely to become impoverished; services directed to expensive curative care) and lack of productivity/reduced efficiency of the healthcare system with a lack of correlation between money spent and healthcare outcomes (WHO Financing report, Aug 2016)

3. LMICs legislate HTA for their universal healthcare coverage schemes
National Health Insurance Act of 2013, Section 11- Excluded Personal Health Services
“The Corporation shall not cover expenses for health services which the Corporation and the DOH consider cost-ineffective through health technology assessment…”
Service coverage (5.3):
“Detailed treatment guidelines, based on available evidence about cost-effective interventions, will be used to guide the delivery of comprehensive health entitlements. Treatment guidelines will be based on evidence regarding the most cost-effective interventions.”
Minister of Health’s Decree No. 71 /2013
Article 34
(5)Health Technology Assessment Committee provide policy recommendation to the Minister on the feasibility of the health service as referred to in paragraph (4) to be included as benefit package of National Health Insurance
11 provincial health bureaus; 29 academic institutions; priority for One Belt One Road policy
“the India Medical Technology Assessment Board for evaluation and appropriateness and cost effectiveness of the available and new Health Technologies in India…standardized cost effective interventions that will reduce the cost and variations in care, expenditure on medical equipment…overall cost of treatment, reduction in out of pocket expenditure of patients…’. Ref: MTAB, Ministry of Health & Family Welfare, Government of India

4. Legacy of stronger technical, institutional and informational capacity in-country to facilitate transition now and in future
Value for Money already in strategies of major development partners and countries legislating the use of evidence to make and defend decisions on spending
Transition is an aspiration shared by all; but transitioning countries stand to lose more than money when donors leave
Global Fund is not just a funding conduit but has responsibility for building local capacity to empower payers in LMICs make it through transition
Market Shaping Strategy, 2015
"On product selection issues and especially cost effectiveness analysis, the Global Fund will partner with organizations that have expertise in HTA…as well as in-country HTA agencies, such as Thailand’s HITAP…an opportunity to build country capacity for health technology assessment and how to incorporate this into product selection decisions.
DFID’s Performance Agreement, 2016
“We welcome the commitment of the Global Fund to…driving value for money and ensure additional expert support in country teams. …the UK will work to strengthen independent advice and scrutiny of the Global Fund to ensure that it is following best practice in seeking value for money."

5. Thank you! Merci!