AIDS and Behavior

, Volume 16, Issue 5, pp 1115–1120

Cost–Utility Analysis of A Female Condom Promotion Program in Washington, DC

  • David R. Holtgrave
  • Catherine Maulsby
  • Michael Kharfen
  • Yujiang Jia
  • Charles Wu
  • Jenevieve Opoku
  • Tiffany West
  • Gregory Pappas
Original Paper

Abstract

A retrospective economic evaluation of a female condom distribution and education program in Washington, DC. was conducted. Standard methods of cost, threshold and cost–utility analysis were utilized as recommended by the U.S. Panel on cost-effectiveness in health and medicine. The overall cost of the program that distributed 200,000 female condoms and provided educational services was $414,186 (at a total gross cost per condom used during sex of $3.19, including educational services). The number of HIV infections that would have to be averted in order for the program to be cost-saving was 1.13 in the societal perspective and 1.50 in the public sector payor perspective. The cost-effectiveness threshold of HIV infections to be averted was 0.46. Overall, mathematical modeling analyses estimated that the intervention averted approximately 23 HIV infections (even with the uncertainty inherent in this estimate, this value appears to well exceed the necessary thresholds), and the intervention resulted in a substantial net cost savings.

Keywords

Female condom HIV prevention Economics Cost-effectiveness analysis Policy analysis 

References

  1. 1.
    Pinkerton SD, Abramson PR, Turk ME. Updated estimates of condom effectiveness. J Assoc Nurses AIDS Care. 1998;9(6):88–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Dowdy DW, Sweat MD, Holtgrave DR. Country-wide distribution of the nitrile female condom (FC2) in Brazil and South Africa: a cost-effectiveness analysis. AIDS. 2006;20(16):2091–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Hirky AE, Kirshenbaum SB, Melendez RM, Rollet C, Perkins SL, Smith RA. The female condom: attitudes and experiences among HIV-positive heterosexual women and men. Women Health. 2003;37(1):71–89.PubMedCrossRefGoogle Scholar
  4. 4.
    District of Columbia Department of Health and George Washington University School of Public Health. District of Columbia Comprehensive HIV/AIDS Behavioral Surveillance Report, 2008. http://dchealth.dc.gov/doh/lib/doh/pdf/dc_hiv_surveillance__summary.pdf. Accessed 30 Aug, 2011.
  5. 5.
    Gold M. Panel on cost-effectiveness in health and medicine. Med Care. 1996;34(12 Suppl):DS197–199.Google Scholar
  6. 6.
    Pinkerton SD, Holtgrave DR. Assessing the cost-effectiveness of HIV prevention interventions: a primer. In: Holtgrave DR, editor. Handbook of economic evaluation of HIV prevention programs. New York and London: Plenum Press; 1998. p. 34–41.Google Scholar
  7. 7.
    Trentacoste ND, Holtgrave DR, Collins C, Abdul-Quader A. Disseminating effective behavioral interventions for HIV prevention: a cost analysis of a risk-reduction intervention for drug users. J Public Health Manag Pract. 2004;10(2):130–9.PubMedGoogle Scholar
  8. 8.
    Holtgrave DR, Briddell K, Little E, et al. Cost and threshold analysis of housing as an HIV prevention intervention. AIDS Behav. 2007;11(6):162–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Holtgrave DR. Costs and consequences of the US Centers for Disease Control and Prevention’s recommendations for opt-out HIV testing. PLoS Med. 2007;4(6):194.CrossRefGoogle Scholar
  10. 10.
    Farnham PG, Holtgrave DR, Sansom SL, Hall HI. Medical costs averted by HIV prevention efforts in the United States, 1991–2006. J Acquir Immune Defic Syndr. 2010;54(5):565–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Walensky RP. Cost-effectiveness of HIV interventions: from cohort studies to clinical trials. Topics in HIV Medicine. 2009;17(4):130–4.PubMedGoogle Scholar
  12. 12.
    Blondon M, Righini M, Bounameaux H, Veenstra DL. Fondaparinux for isolated superficial-vein thrombosis of the legs: a cost-effectiveness analysis. Chest. Jul 14 2011.Google Scholar
  13. 13.
    Grosse SD. Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Expert Rev Pharmacoecon Outcomes Res. 2008;8(2):165–78.PubMedCrossRefGoogle Scholar
  14. 14.
    Hornberger JC, Best JH, Garrison LP Jr. Cost-effectiveness of repeat medical procedures: kidney transplantation as an example. Med Decis Making. 1997;17(4):363–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Holtgrave DR, Wolitski RJ, Pals SL, et al. Cost–utility analysis of the housing and health intervention for homeless and unstably housed persons living with HIV. Manuscript submitted for publication.Google Scholar
  16. 16.
    Smith DK, Grohskopf LA, Black RJ, et al. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States. MMWR Morb Mortal Wkly Rep. 2005;54(RR02):1–20.Google Scholar
  17. 17.
    Hoke TH, Feldblum PJ, Van Damme K, Nasution MD, Grey TW, Wong EL, Ralimamonjy L, Raharimalala L, Rasamindrakotroka A. Temporal trends in sexually transmitted infection prevalence and condom use following introduction of the female condom to Madagascar sex workers. Int J STD AIDS. 2007;18:461–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • David R. Holtgrave
    • 1
  • Catherine Maulsby
    • 1
  • Michael Kharfen
    • 2
  • Yujiang Jia
    • 2
  • Charles Wu
    • 2
  • Jenevieve Opoku
    • 2
  • Tiffany West
    • 2
  • Gregory Pappas
    • 2
  1. 1.Department of Health, Behavior & SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.HIV/AIDS, Hepatitis, STD & TB AdministrationD.C. Department of HealthWashingtonUSA

Personalised recommendations