Using cost-effectiveness analyses to inform policy: the case of antiretroviral therapy in Thailand
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BioMed Central
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Using cost-effectiveness analyses to inform policy: the case of antiretroviral therapy in Thailand Sripen Tantivess*1 and Gill Walt2 Address: 1International Health Policy Programme, Bureau of Policy and Strategy, Ministry of Public Health, Nonthaburi, Thailand and 2London School of Hygiene and Tropical Medicine, London, UK Email: Sripen Tantivess* - [email protected]; Gill Walt - [email protected] * Corresponding author
Published: 30 December 2006 Cost Effectiveness and Resource Allocation 2006, 4:21
doi:10.1186/1478-7547-4-21
Received: 25 August 2006 Accepted: 30 December 2006
This article is available from: http://www.resource-allocation.com/content/4/1/21 © 2006 Tantivess and Walt; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Much emphasis is put on providing evidence to assist policymakers in priority setting and investment decisions. Assessing the cost-effectiveness of interventions is one technique used by policymakers in their decisions around the allocation of scarce resources. However, even where such evidence is available, other considerations may also be taken into account, and even over-ride technical evidence. Antiretroviral therapy (ART) is the most effective intervention to reduce HIVrelated morbidity and prolong mortality. However, treatment provision in the developing world has been hindered by the high costs of services and drugs, casting doubts on its cost-effectiveness. This paper looks at Thailand's publicly-funded antiretroviral initiative which was first introduced in 1992, and explores the extent to which cost-effectiveness evidence influenced policy. Methods: This article reviews the development of the national ART programme in Thailand between 1992 and 2004. It examines the roles of cost-effectiveness information in treatment policy decisions. Qualitative approaches including document analysis and interview of key informants were employed. Results: Two significant policy shifts have been observed in government-organised ART provision. In 1996, service-based therapy for a few was replaced by a research network to support clinical assessments of antiretroviral medication in public hospitals. This decision was taken after a domestic study illustrated the unaffordable fiscal burden and inefficient use of resources in provision of ART. The numbers of treatment recipients was maintained at 2,000 per year throughout the 1990s. It was not until 2001 that a new government pledged to extend the numbers receiving the service, as part of its commitment to universal coverage. Several elements played a role in this decision: new groups of dominant actors, drug price reductions, a pro-active civil society movement, lessons from experience on treatment benefits, and global treatm
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