04. c. storti - hiv outbreaks among pwid in europe. c. storti... · hiv outbreaks among pwid in...

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?

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



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



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)





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)



(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)



(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


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)


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!

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