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Erschienen in: The European Journal of Health Economics 3/2010

01.06.2010 | Original Paper

The welfare costs of HIV/AIDS in Eastern Europe: an empirical assessment using the economic value-of-life approach

verfasst von: Julia Fimpel, Michael Stolpe

Erschienen in: The European Journal of Health Economics | Ausgabe 3/2010

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Abstract

Based on the aggregation of individual willingness-to-pay for a statistical life, we calibrate an inter-temporal optimisation model to determine the aggregate welfare loss from HIV/AIDS in 25 Eastern European countries. Assuming a discount rate of 3%, we find a total welfare loss for the whole region that exceeds US $800 billion, approximately 10% of the region’s annual GDP between 1995 and 2001. Although prevalence and incidence rates diverge sharply between countries—with central Europe far less affected than major countries in the Commonwealth of Independent States and the Baltics—the epidemic is likely to spread to all countries unless a coherent strategy of prevention and treatment is backed up by substantial increases in healthcare investments. The sheer size of this task and the international nature of the epidemic render this one of the most important current challenges for all of Europe.
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Fußnoten
1
In this vein, Stover et al. [8] estimate the costs for prevention per infection averted in Eastern Europe at US $ 9,148 and compare this with an estimated net present value of lifetime treatment at US $ 11,203 to infer savings of US $ 2,055 per infection averted during the 2005–2015 period. The value-of-life methodology suggests these cost savings are only a small fraction of the total social value of lower HIV infection rates.
 
2
The health economics literature has not found a consensus on the correct discount rate. Viscusi and Moore [9] suggest a discount rate between 1% and 14%, yet newer estimates lie mostly below 10%. Based on contingent valuation, instead of revealed preferences as in wage compensations for occupational risks, Johannesson and Johansson [10] find discount rates for life years between 0 and 3%, Cairns and van der Pol [11] for health effects between 6 and 9%, whereas Ganiats et al. [37] find rates from negative to 116%. See also Frederick et al. [12].
 
3
For Albania, the Czech Republic and Slovenia, no original data on ART access are available. To obtain a rough estimate for these countries, we ran an ordinary least squares regression of ART coverage for HIV + persons in the other countries of our sample on real GDP per capita and a constant, yielding (absolute value of t-statistics in parentheses): ART cover = −0.064 (0.55) + 0.073 (4.85)** RGDP based on 22 observations with R2 equal to 51%. The slope coefficient is significant at the 1% level. Using data on real GDP per capita, we obtained predictions for the countries with missing information on ART coverage among HIV + persons.
 
4
A descriptive survey of national responses to HIV/AIDS in the Western Balkans and of recommendations for region-wide activities is provided in Godinho et al. [22].
 
5
This review is the fifth in a series of six papers that Lancet published in 2008 about HIV prevention, surveying the state-of-the-art in biomedical, behavioural and structural approaches.
 
6
The Laspeyres-Index is the geometric mean of the price ratios for products characteristic of a base country, regardless of whether the products are representative or not of the other countries to be compared with. The Laspeyres Index produces a bias because it does not take into account the changes in relative prices, and hence, substitution effects in consumption. That is why in higher income countries, the costs of living still supersede those of countries with lower per-capita income. This could explain why, for countries with a higher income, the calculated life-death indifference parameter α is lower.
 
7
Between 1990 and 1995, Hungary exported very much the same products (Hoekman and Djankov [31]), while Romania and Bulgaria changed their composition of exports significantly (especially with regard to the EU). Kazakhstan and Russia’s principal exports are oil (which is why they owe their positive GDP growth to rising international oil and gas prices). Georgia’s main export items are metals, wine and mineral water. The same applies to Moldova and to Ukraine, a metal and steel-exporter. All of these countries are vulnerable to changes in the external economic environment because of their narrow export base.
 
8
The country-specific estimates were obtained by the UNAIDS/WHO [24] working group in two basic steps. First, point prevalence estimates for 1994 and 1997 were carried out and the starting year of the epidemic was determined for each country. In a second step, these estimates of prevalence over time and the starting date of the epidemic were used to determine the epidemic curve that best described the spread of HIV in each particular country. A simple epidemiological program (EPIMODEL) was used for the calculation of estimates on incidence and mortality from this epidemic curve.
 
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Metadaten
Titel
The welfare costs of HIV/AIDS in Eastern Europe: an empirical assessment using the economic value-of-life approach
verfasst von
Julia Fimpel
Michael Stolpe
Publikationsdatum
01.06.2010
Verlag
Springer-Verlag
Erschienen in
The European Journal of Health Economics / Ausgabe 3/2010
Print ISSN: 1618-7598
Elektronische ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-009-0177-y

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