Measuring the contributions of prevention and treatment of illness to changing life expectancy with avoidable mortality as the outcome indicator: how to deal with new diseases

Abstract

BackgroundAvoidable mortality is an important outcome indicator of the effectiveness of health care. It is commonly used to quantify the contribution of health care to changes in life expectancy among people dying prematurely. This method assumes that the only determinants of avoidable mortality are those of health care, which can be separated into prevention and treatment contributions. However, there might be other determinants. If so, the apportionment into prevention or treatment gives an erroneous picture; this occurs when a new disease manifests itself, and mortality increases. We illustrate this by examining the history of HIV infection since its emergence as a new disease, and propos..