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National HIV Prevention Conference
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[TITLE:] DETERMINING THE INTENSITY OF PREVENTION INTERVENTIONS FOR PERSONS LIVING WITH HIV: AN APPLICATION OF ECONOMIC THRESHOLD ANALYSIS
Natl HIV Prev Conf. 2005 Jun 12-15 (abstract no. M1-E0101)
Holtgrave, D
Emory University School of Public Health, Atlanta, GA
BACKGROUND: A growing body of scientific literature focuses on studies of the effectiveness of interventions that aim to prevent the transmission of HIV from persons living with HIV to seronegative partners. These studies have examined interventions with very wide variations in intensity (from single session interventions to those offered twice-weekly for six months); this wide variation in intensity raises questions about cost-effectiveness. Here, we ask: At varied (but specified) levels of HIV transmission rates and intervention effectiveness, how much money can be spent per HIV seropositive client on HIV prevention services and the investment still be considered cost-saving to society (in terms of HIV transmissions prevented)?
METHODS: Standard methods of economic evaluation (threshold analysis, in particular) were used. We specified but widely varied per-client HIV transmission rates and intervention effectiveness; we then calculated the threshold for intervention cost (as well as number of sessions per client) that could be justified on the basis of societal cost savings.
RESULTS: If HIV transmissions are permanently prevented and lifetime medical costs are avoided in an HIV seronegative partner, then monthly counseling sessions . even after high quality pre- and post-test counseling, and even at moderate levels of effectiveness -maybe cost-saving to society (and at higher transmission rates and effectiveness, dozens of sessions per client could be cost-saving). If these interventions delay (but do not permanently prevent) HIV infection among HIV seronegative partners, then the cost and number of session thresholds are substantially lower.
CONCLUSIONS: Even with substantial uncertainty in input parameters, an economic evaluation threshold analysis framework can yield useful insights for guiding the selection of intensity of HIV prevention services for persons living with HIV. For any given combination of transmission rate and intervention effectiveness in a given community, these results provide a cost-saving threshold that might be a useful guide in funding decisions.
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050612
M1-E0101
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