Abstract
The Housing and Health study examines the effects of permanent supportive housing for homeless and unstably housed persons living with HIV. While promising as an HIV prevention intervention, providing housing may be more expensive to deliver than some other HIV prevention services. Economic evaluation is needed to determine if investment in permanent supportive housing would be cost-saving or cost-effective. Here we ask––what is the per client cost of delivering the intervention, and how many HIV transmissions have to be averted in order to exceed the threshold needed to claim cost-savings or cost-effectiveness to society? Standard methods of cost and threshold analysis were employed. Payor perspective costs range from $9,256 to $11,651 per client per year; societal perspective costs range from $10,048 to $14,032 per client per year. Considering that averting a new case of HIV saves an estimated $221,365 in treatment costs, the average cost-saving threshold across the three study cities is 0.0555. Expressed another way, if just one out of every 19 Housing & Health intervention clients avoided HIV transmission to an HIV seronegative partner the intervention would be cost-saving. The intervention would be cost-effective if it prevented just one HIV transmission for every 64 clients served.
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References
Aidala, A., Cross, J. E., Stall, R., Harre, D., & Sumartojo, E. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS & Behavior, 9, 251–265.
Department of Housing and Urban Development (2007) Fair Market Rent History. World wide web document available at http://www.huduser.org/datasets/fmr/fmrs/. Accessed April 6, 2007.
Gold, M. R., Siegel J. E., Russell L. B., Weinstein M. C. (Eds.) (1996). Cost-effectiveness in health and medicine. New York, NY: Oxford University Press.
Gorsky, R. D. (1996). A method to measure the costs of counseling for HIV prevention. Public Health Reports, 111, 115–122.
Holtgrave D. R. (Ed.) (1998). Handbook of economic evaluation of HIV prevention programs. New York, NY: Plenum Press.
Holtgrave, D. R., & Pinkerton, S. D. (1997). Updates of cost of illness and quality of life estimate for use in economic evaluation of HIV prevention programs. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 16, 54–62.
Hutchinson, A. B., Farnham, P. G., Dean, H. D., Edwueme, D. U., del Rio, C., Kamimoto, L., & Kellerman, S. E. (2006). The economic burden of HIV in the United States in the era of highly active antiretroviral therapy: Evidence of continuing racial and ethnic differences. Journal of Acquired Immune Deficiency Syndromes, 43, 451–457.
Kidder, D. P., Wolitski, R. J., Royal, S., Aidala, A., Courtenay-Quirk, C., Holtgrave, D. R., Harre, D., Sumartojo, E., Stall, R., Housing and Health Study Team. (in press, this issue) Access to housing as a structural intervention for homeless and unstably housed people living with HIV: Rationale, methods, and implementation of the Housing and Health Study. AIDS & Behavior, this issue, doi: 10.1007/s10461-007-9249-0, http://www.springerlink.com/content/b64k8377g1865051/?p=765aa4e17e2d4221a3f328d90a0d0de3&pi=0
Pinkerton, S. D., Johnson-Masotti, A. P., Holtgrave, D. R., & Farnham, P. G. (2001). Using cost-effectiveness league tables to compare interventions to prevent sexual transmission of HIV. AIDS, 15, 917–928.
Prosser, L. A., Buxton Bridges, C., Uyeki, T. M., Hinrichsen, V. L., Meltzer, M. I., Nolinari, N-A. M., Schwartz, B., Thompson, W. W., Fukuda, K., & Lieu, T. A. (2006). Health benefits, risks, and cost-effectiveness of influenza vaccination of children. Emerging Infectious Diseases, 12, 1548–1558.
Schackman, B. R., Gebo, K. A., Walensky, R. P., Losina, E., Muccio, T., Sax, P. E., Weinstein, M. C., Seage, G. R. 3rd, Moore, R. D., & Freedberg, K. A. (2006). The lifetime cost of current human immunodeficiency virus care in the United States. Medical Care, 44, 990–997.
Trentacoste, N. D., Holtgrave, D. R., Collins, C., & Abdul-Quader, A. (2004). Disseminating effective behavioral interventions for HIV prevention: A cost analysis of a risk-reduction intervention for drug users. Journal of Public Health Management and Practice, 10, 130–139.
Tufts-New England Medical Center. (2007). CEA Registry. World Wide Web document available at http://www.tufts-nemc.org/cearegistry/data/default.asp. Accessed April 6, 2007.
Varghese, B., Peterman, T. A., & Holtgrave, D. R. (1999). Cost-effectiveness of counseling and testing and partner notification: A decision analysis. AIDS, 13, 1745–1751.
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For the Housing and Health Study Team. Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
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Holtgrave, D.R., Briddell, K., Little, E. et al. Cost and Threshold Analysis of Housing as an HIV Prevention Intervention. AIDS Behav 11 (Suppl 2), 162–166 (2007). https://doi.org/10.1007/s10461-007-9274-z
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DOI: https://doi.org/10.1007/s10461-007-9274-z