HIV outbreaks among PWID in Europe linking economic, epidemiological and service provision data -

Transcription

1 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 / HIV Risk assessment Claudia Costa Storti, EMCDDA

2 Economic recession - crisis 2

3 Economic recession - crisis 8 % Gross Domestic Product growth rate, constant prices World European Union Source: IMF 3

4 Economic recession - unemployment 4

5 Economic recession - unemployment Unemployment rate in the EU(27) % Total (right axis) Youth - ages (left axis) % 5 0 5

6 Economic recession - austerity 6

7 Economic recession - austerity 7

8 Economic recession health? 8

9 Economic recession health? Public expenditure on health, EU(27) real growth rate real gf07 growth rate

10 Economic recession social protection? 10

11 Economic recession social protection? Public expenditure on social protection, EU(27) 11

12 Economic recession Financing of drug treatment Financing health and social protection Problem drug use? 12

13 Economic recession Financing of drug treatment Financing health and social protection Problem drug use? 13

14 We need better evaluation systems Thomas Babor, 23.sep.2013 Only better evaluation systems allow the best allocation of scarce resources We need better data on costs of treatment!

15 Costs of KEY measures for HIV prevention Costs of Opioid Subs Treatment Costs of Needle Exchange Programmes 15

16 Financing HIV prevention What 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? 16

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18 LITERATURE SURVEY ON THE METHODS USED TO ESTIMATE PUBLIC EXPENDITURE by Freya Vander Laenen and Delfine Lievens, 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 18

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 19

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) 20

21 Settings Source: Haase T, Pratschke J and Engling F (2012) 21

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 22

23 Method - Drug specific Repartition Specific Unit ESTIMATES 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) 23

24 Method Repartition key Repartition Specific Unit ESTIMATES 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) 24

25 Method Unit expenditure Repartition Specific Unit ESTIMATES 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 ) 25

26 Public expenditure on harm reduction programmes Repartition Specific Unit ESTIMATES CALCULATION METHODS FOR HARM REDUCTION PROGRAMMES (EXPRESSED IN NUMBER OF STUDIES) Source: Vander Laenen F. and Lievens D. (2013) 26

27 Methods mostly used Repartition Specific Unit ESTIMATES CALCULATION METHODS FOR OPIOID SUBSTITUTION TREATMENT BY GENERAL PRACTITIONERS reimbursement cost for a consultation x number of consultations for substitution treatment Source: Vander Laenen F. and Lievens D. (2013) 27

28 Methods mostly used Repartition Specific Unit ESTIMATES CALCULATION METHODS FOR MEDICAL PRESCRIPTIONS (EXPRESSED IN NUMBER OF STUDIES) Source: Vander Laenen F. and Lievens D. (2013) 28

29 Methods mostly used Repartition Specific Unit CALCULATION METHODS FOR MEDICAL PRODUCTS ESTIMATES 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 29

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. 30

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 31

32 Economics, epidemiological and service provision data Comments or questions? Thanks for your attention! Cláudia Costa Storti, MSc Scientific analyst Economic analysis Policy, evaluation and content coordination unit Tel. (351) Fax (351) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 32