The Price of Nonabandonment: HIV in Resource-Limited Settings

• 成果类型: Article
• 署名作者: Khademi, Amin; Saure, Denis R.; Schaefer, Andrew J.; Braithwaite, Ronald S.; Roberts, Mark S.
• 署名单位: Clemson University; Universidad de Chile; Pennsylvania Commonwealth System of Higher Education (PCSHE); University of Pittsburgh; New York University; Pennsylvania Commonwealth System of Higher Education (PCSHE); University of Pittsburgh
• 刊物名称: M&SOM-MANUFACTURING & SERVICE OPERATIONS MANAGEMENT
• ISSN/ISSBN: 1523-4614
• DOI: 10.1287/msom.2015.0545
• 发表日期: 2015
• 页码: 554-570
• 关键词: hiv; resistance; nonabandonment allocation policy; Approximate Dynamic Programming

摘要

The global fight against HIV/AIDS is hindered by a lack of drugs in the developing world. When patients in these countries initiate treatment, they typically remain on it until death; thus, policy makers and physicians follow nonabandonment policies. However, treated patients develop resistance to treatment, so in many cases untreated patients might benefit more from the drugs. In this paper we quantify the opportunity cost associated with restricting attention to nonabandonment policies. For this, we use an approximate dynamic programming framework to bound the benefit from allowing premature treatment termination. Our results indicate that in sub-Saharan Africa, the price associated with restricting attention to nonabandonment policies lies between 4.4% and 8.1% of the total treatment benefit. We also derive superior treatment allocation policies, which shed light on the role behavior and health progression play in prioritizing treatment initiation and termination.