Portfolios of Biomedical HIV Interventions in South Africa: A Cost-Effectiveness Analysis
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Recent clinical trials of male circumcision, oral pre-exposure prophylaxis (PrEP), and a vaginal microbicide gel have shown partial effectiveness at reducing HIV transmission, stimulating interest in implementing portfolios of biomedical prevention programs.
To evaluate the effectiveness and cost-effectiveness of combination biomedical HIV prevention and treatment scale-up in South Africa, given uncertainty in program effectiveness.
Dynamic HIV transmission and disease progression model with Monte Carlo simulation and cost-effectiveness analysis.
Men and women aged 15 to 49 years in South Africa.
HIV screening and counseling, antiretroviral therapy (ART), male circumcision, PrEP, microbicide, and select combinations.
HIV incidence, prevalence, discounted costs, discounted quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios.
Providing half of all uninfected persons with PrEP averts 28 % of future HIV infections for $9,000/QALY gained, but the affordability of such a program is questionable. Given limited resources, annual HIV screening and ART utilization by 75 % of eligible infected persons could avert one-third of new HIV infections, for approximately $1,000/QALY gained. Male circumcision is more cost-effective, but disproportionately benefits men. A comprehensive portfolio of expanded screening, ART, male circumcision, microbicides, and PrEP could avert 62 % of new HIV infections, reducing HIV prevalence from a projected 14 % to 10 % after 10 years. This strategy doubles treatment initiation and adds 31 million QALYs to the population. Despite uncertainty in program effectiveness, a comprehensive portfolio costs less than $10,000/QALY gained in 33 % of simulation iterations and less than $30,000/QALY gained in 90 % of iterations, assuming an annual microbicide cost of $100.
A portfolio of modestly-effective biomedical HIV prevention programs, including male circumcision, vaginal microbicides, and oral PrEP, could substantially reduce HIV incidence and prevalence in South Africa and be likely cost-effective. Given limited resources, PrEP is the least cost-effective intervention of those considered.
- Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380(9859):2095–2128. CrossRef
- Salomon JA, Vos T, Hogan DR, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet. 2013;380(9859):2129–2143. CrossRef
- Wang H, Dwyer-Lindgren L, Lofgren KT, et al. Age-specific and sex-specific mortality in 187 countries, 1970-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380(9859):2071–2094. CrossRef
- Joint United Nations Programme on HIV/AIDS (UNAIDS). Report on the global AIDS epidemic. Geneva 2010.
- Kates J, Boortz K, Lief E, Avila C, Bobet G. Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from the G8, European Commission and Other Donor Governments in 2009, Washington, DC: Kaiser Family Foundation and UNAIDS; 2010.
- Joint United Nations Programme on HIV/AIDS (UNAIDS). World AIDS Day Report. Geneva 2011.
- Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2(11):e298. CrossRef
- Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369(9562):643–656. CrossRef
- Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369(9562):657–666. CrossRef
- Siegfried N, Muller M, Deeks JJ, Volmink J. Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane database of systematic reviews (Online). 2009(2):CD003362.
- Abdool Karim Q, Abdool Karim SS, Frohlich JA, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329(5996):1168–1174. CrossRef
- Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–2599. CrossRef
- Van Damme L, Corneli A, Ahmed K, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367(5):411–422. CrossRef
- Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410. CrossRef
- Thigpen MC, Kebaabetswe PM, Paxton LA, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–434. CrossRef
- Hankins CA, de Zalduondo BO. Combination prevention: a deeper understanding of effective HIV prevention. AIDS. 2010;24(Suppl 4):S70–80. CrossRef
- Kurth AE, Celum C, Baeten JM, Vermund SH, Wasserheit JN. Combination HIV prevention: significance, challenges, and opportunities. Curr HIV/AIDS Rep. 2011;8(1):62–72. CrossRef
- Folkers GK, Fauci AS. Controlling and ultimately ending the HIV/AIDS pandemic: a feasible goal. JAMA. 2010;304(3):350–351. CrossRef
- National Institute of Allergy and Infectious Diseases (NIAID). HIV Study Named 2011 Breakthrough of the Year by Science. 2011; http://www.niaid.nih.gov/news/newsreleases/2011/Pages/HPTN052Breakthrough.aspx. Accessed January 25, 2013.
- Excler JL, Rida W, Priddy F, et al. AIDS vaccines and preexposure prophylaxis: is synergy possible? AIDS Res Hum Retroviruses. 2011;27(6):669–680. CrossRef
- Stover J, Bertozzi S, Gutierrez JP, et al. The global impact of scaling up HIV/AIDS prevention programs in low- and middle-income countries. Science. 2006;311(5766):1474–1476. CrossRef
- Hogan DR, Baltussen R, Hayashi C, Lauer JA, Salomon JA. Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries. BMJ. 2005;331(7530):1431–1437. CrossRef
- Salomon JA, Hogan DR, Stover J, et al. Integrating HIV prevention and treatment: from slogans to impact. PLoS Med. 2005;2(1):e16. CrossRef
- Long EF, Brandeau ML, Owens DK. The cost-effectiveness and population outcomes of expanded HIV screening and antiretroviral treatment in the United States. Ann Intern Med. 2010;153:778–789. CrossRef
- Hallett TB, Baeten JM, Heffron R, et al. Optimal Uses of Antiretrovirals for Prevention in HIV-1 Serodiscordant Heterosexual Couples in South Africa: A Modelling Study. PLoS Med. 2011;8(11):e1001123. CrossRef
- Long EF, Brandeau ML, Owens DK. Potential population health outcomes and expenditures of HIV vaccination strategies in the United States. Vaccine. 2009;27(39):5402–5410. CrossRef
- Gold MR, Siegel JE, Russell LB, Weinstein MC, eds. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press; 1996.
- Shisana O, Rehle T, Simbayi L, et al. South African national HIV prevalence, HIV incidence, behaviour and communication survey, 2008: A turning tide among teenagers? Cape Town: HSRC Press; 2009.
- South Africa Department of Health. Country progress report on the Declaration of Commitment on HIV/AIDS. Pretoria: Department of Health; 2010.
- World Health Organization Commission on Macroeconomics and Health. Macroeconomics and Health: Investing in Health for Economic Development. Geneva 2001.
- Freedberg KA, Losina E, Weinstein MC, et al. The cost effectiveness of combination antiretroviral therapy for HIV disease. N Engl J Med. 2001;344(11):824–831. CrossRef
- Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. CrossRef
- Cohen MS, Baden LR. Preexposure prophylaxis for HIV–where do we go from here? N Engl J Med. 2012;367(5):459–461. CrossRef
- Shisana O, Rehle T, Simbayi L, et al. South African national HIV prevalence, HIV incidence, behaviour and communication survey, 2005. Cape Town: HSRC Press; 2005.
- South Africa Department of Health, Medical Research Council. South Africa demographic and health survey 2003. Pretoria: Department of Health; 2007.
- Portfolios of Biomedical HIV Interventions in South Africa: A Cost-Effectiveness Analysis
Journal of General Internal Medicine
Volume 28, Issue 10 , pp 1294-1301
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- HIV epidemic
- mathematical model
- cost-effectiveness analysis
- combination HIV prevention
- Industry Sectors