Making Better Decision: Policy Modeling for AIDS and Drug Abuse [I]

Investigator: James Kahn, MD, MPH
Sponsor: Stanford University

Location(s): United States


This project aims to promote reasoned policy making in the realm of AIDS and drug abuse prevention via the development of mathematical and economic models.  Specifically, the project goal is to evaluate existing and potential HIV and substance abuse interventions in order to provide critical information about intervention effectiveness, public-health impact, and efficiency. We will use mathematical and economic models to assess how well programs work in terms of their health outcomes (e.g., lives saved and years of life gained) and cost, and will evaluate their economic efficiency.  Our research includes methodological aims, but our focus is on the decision maker and on strengthening the linkages of formal analysis to the planning and policy process.

Our methodological aims are:

1. To estimate production functions that characterize the relationship between program expenditures and health outcomes, such as reductions in risky behaviors (e.g., needle sharing) for prevention programs and delivery of services (e.g., person-years of antiretroviral therapy) for treatment programs.

2.  To develop model-based methods of translating the behavioral and clinical impact of HIV-related interventions into epidemiologically meaningful outcome measures, such as HIV infections averted and years of life saved.

3.  To determine how best to estimate health outcomes (e.g., HIV infections averted and years of life saved), economic outcomes (e.g., direct medical costs averted and total economic savings to society), and cost effectiveness (e.g., incremental cost per quality-adjusted year of life saved) of HIV and substance abuse interventions.

The first three aims represent our plan to advance the methods of AIDS policy modeling. This work serves as the foundation for our applied aims, which are:

4.  To assess the effectiveness and cost effectiveness of specific interventions aimed at preventing and treating HIV and substance abuse.

5. To inform the allocation of societal resources by examining the effectiveness and cost effectiveness of portfolios of prevention and treatment interventions. This work includes analyzing national and international HIV prevention and treatment strategies, and assessing how to balance HIV prevention and treatment interventions to achieve the greatest health benefit.

In keeping with our policy orientation and our focus on the decision maker, our sixth aim is:

6. To examine the relationship between policy modeling and public health decision making in the areas of HIV and substance abuse – in particular, to explore how to make analyses most useful to policy makers.

Our overarching goal is to provide the best available scientific basis for resource allocation decisions in HIV and substance abuse treatment and prevention.  The proposed research will advance the state of the art in HIV planning and policy modeling, and will critically evaluate promising interventions and portfolios of interventions to help provide the scientific foundation for allocating scarce resources for HIV and substance abuse prevention and treatment.