Optimal Spending on HIV Prevention and Treatment: A Framework for Evaluating Cost-Effectiveness with Example Application to the India AIDS Initiative .............. margaret l. brandeau, elisa f. long, david w. hutton, and douglas k. owens

Abstract Resources to control the spread of human immunodeficiency virus (HIV) are insufficient to meet all needs. To achieve the maximum health benefit with limited resources, information about program costeffectiveness is needed. We present a model-based framework for evaluating the cost-effectiveness of HIV prevention and treatment programs, which we illustrate by suggesting how programs in the Gates Foundation’s India AIDS Initiative could be assessed. A framework of this type can help identify the most cost-effective programs in a portfolio of HIV interventions, thus guiding the allocation (and possible reallocation) of scarce funds. Additionally, a model-based framework allows one to see how cost-effectiveness estimates and policy conclusions may change for different values of uncertain parameters, and helps identify areas where further data collection is most critically needed.