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HIV outbreaks among PWID in Europe
– linking economic, epidemiological and
service provision data -
EMCDDA annual expert meeting on drug-related deaths
and drug-related infectious diseases
18/10 /2013 - HIV Risk assessment
Claudia Costa Storti, EMCDDA
2
Economic recession - crisis
3
Economic recession - crisis
Gross Domestic Product growth rate, constant prices
-8
-6
-4
-2
0
2
4
6
8
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
%
World
European Union
Source: IMF
4
Economic recession - unemployment
5
Economic recession - unemployment
Unemployment rate in the EU(27)
0
2
4
6
8
10
12
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
%
%
0
5
10
15
20
25
Total (right axis)
Youth - ages 15-24 (left axis)
6
Economic recession - austerity
7
Economic recession - austerity
8
Economic recession – health?
9
Economic recession – health?
-2.0
-1.0
0.0
1.0
2.0
3.0
4.0
5.0
6.0
2003 2004 2005 2006 2007 2008 2009 2010 2011
rea
l gro
wth
ra
te
real gf07 growth rate
Public expenditure on health, EU(27)
10
Economic recession – social protection?
11
Economic recession – social protection?
Public expenditure on social protection, EU(27)
12
Problem drug use?
Financing health
and social protection
Financing of
drug treatment
Economic
recession
13
Problem drug use?
Financing health
and social protection
Financing of
drug treatment
Economic
recession
‘We need better evaluation systems’
Thomas Babor, 23.sep.2013
Only better evaluation systemsallow the best allocation of scarce
resources
We need better data on costs oftreatment !
15
Costs of KEY measures for HIV prevention
Costs of Opioid Subs Treatment
Costs of Needle Exchange Programmes
16
Financing HIV preventionWhat do we would like to know?
1. Any changes in the financing of OST and
NSP after 2008?
2. Changes affected service provision?
3. Could you obtain national data on public
expenditure on OST and NSP?
4. Other changes in health/social protection
impacting on these services?
5. How this may have affected service
provision?
17
18
LITERATURE SURVEY ON THE METHODS USED TO
ESTIMATE PUBLIC EXPENDITURE
by Freya Vander Laenen and Delfine Lievens, 2013
1. Methods used to estimate public expenditure
on treatment differ in Europe;
2. Vary according to the type of treatment and
data available;
3. Detailed information about specific drug
treatment provision is some times available
19
General conceptual framework:
1. Define geographical coverage (national);
2. Define time period (annual);
3. Identify levels of government involved;
4. Identify settings of treatment provision;
5. Chose estimation methods:1. Inter-action between data available and estimation
methods
2. Survey of possible methods available
20
Levels of government
1. Central government (in nation states)
2. State government (in federal governments)
3. Local government (includes regional/local
and municipalities)
4. Social security (this level of government is most of the times centralized
and includes action programs of governments intended to guarante access to sufficient resources to everyone)
21
Settings
Source: Haase T, Pratschke J and Engling F (2012)
22
Methods
The choice of the method is most of the times
pragmatic and depends on data availability
Methods mostly used:
1. Drug specific
2. Repartition key
3. Unit expenditure
23
Method: does not require any calculation, because it accounts for
expenditure on illicit drug treatment only
Data: frequently available in public documents
(Ex: budget articles, annual reports, and/or reports from governmental
agencies or public institutes)
Method - Drug specific
Method: does not require any calculation, because it accounts for
expenditure on illicit drug treatment only
Data: frequently available in public documents
(Ex: budget articles, annual reports, and/or reports from governmental
agencies or public institutes)
ESTIMATES
Unit
RepartitionSpecific
24
Method: Drug-related expenditure is isolated from the wider budgets,
with a proration technique
(ex: nº of OST visits divided by the total nº of treatment visits)
Data: frequently available in public accountancy or accounts of
broader treatment facilities/hospitals
(Ex: budget articles, annual reports, and/or reports from governmental
agencies or public institutes)
Method – Repartition key
Method: Drug-related expenditure is isolated from the wider budgets,
with a proration technique
(ex: nº of OST visits divided by the total nº of treatment visits)
Data: frequently available in public accountancy or accounts of
broader treatment facilities/hospitals
(Ex: budget articles, annual reports, and/or reports from governmental
agencies or public institutes)
ESTIMATES
Unit
RepartitionSpecific
25
Method: Departs from the cost of a single unit of treatment and
multiplies by the number of units of treatment provided
(ex: average cost for an OST visit multiplied by the total nº of visits)
Data: frequently available in public accountancy or accounts of
broader treatment facilities/hospitals
(Ex: national statistics, studies, etc )
Method – Unit expenditure
Method: Departs from the cost of a single unit of treatment and
multiplies by the number of units of treatment provided
(ex: average cost for an OST visit multiplied by the total nº of visits)
Data: frequently available in public accountancy or accounts of
broader treatment facilities/hospitals
(Ex: national statistics, studies, etc )
ESTIMATES
Unit
RepartitionSpecific
26
Public expenditure onharm reduction programmes
ESTIMATES
Unit
RepartitionSpecific
CALCULATION METHODS FOR HARM REDUCTION PROGRAMMES
(EXPRESSED IN NUMBER OF STUDIES)
Source: Vander Laenen F. and Lievens D. (2013)
27
MethodsMethods – mostly used
ESTIMATES
Unit
RepartitionSpecific
CALCULATION METHODS FOR OPIOID SUBSTITUTION
TREATMENT BY GENERAL PRACTITIONERS
Source: Vander Laenen F. and Lievens D. (2013)
reimbursement cost for a consultation x number of consultations
for substitution treatment
28
MethodsMethods – mostly used
ESTIMATES
Unit
RepartitionSpecific
CALCULATION METHODS FOR MEDICAL PRESCRIPTIONS
(EXPRESSED IN NUMBER OF STUDIES)
Source: Vander Laenen F. and Lievens D. (2013)
29
Methods – mostly used
ESTIMATES
Unit
RepartitionSpecific
CALCULATION METHODS FOR MEDICAL PRODUCTS
1. Pharmaceuticals are often included in the overall costs of OST;
2. Otherwise:
o Proration technique:
total amount of drugs purchased* % of medical conditions caused by
drug use
o Unit cost:reimbursed cost of medicines x number of prescriptions to treat drug
disorders
30
Step by step procedure Estimating public expenditure on OST and NSP
1) Identify the service providers of the OST and NSP;
2) Ask service providers how is their financing organized; if they have an identified budget for these two programmes (drug specific) or if their budget is included in other wider budgets;
3) Identify drug specific expenditure available for these programmes;
4) In case there are no drug specific budgets or, they only account for part of the total, use either the proration technique or the unit expenditure technique to complete estimates. The selection of one of these methods will be based in the secondary data available;
5) If necessary, extrapolate results with caution and; compare with other available extrapolations or studies.
31
Austerity, public expenditure on health and drug
• A better understanding of the impact of 2008 economic recession allows to better deal with problem drug use
• Public austerity impacts on the provision of HIV prevention
• We know little
• We need to better assess the costs of key measures for HIV prevention
• The EMCDDA is fully available to cooperate and to support national estimates
32
Cláudia Costa Storti, MSc
Scientific analyst — Economic analysis • Policy, evaluation and content coordination unitTel. (351) 211 21 02 54 • Fax (351) 213 58 44 [email protected]
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
Economics, epidemiological and service provision data
Comments or questions?
Thanks for your attention!