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Cost-Effectiveness of Interventions to Prevent HIV and STDs Among Women: A Randomized Controlled Trial

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Abstract

Injection drug use is a leading transmission route of HIV and STDs, and disease prevention among drug users is an important public health concern. This study assesses cost-effectiveness of behavioral interventions for reducing HIV and STDs infections among injection drug-using women. Cost-effectiveness analysis was conducted from societal and provider perspectives for randomized trial data and Bernoullian model estimates of infections averted for three increasingly intensive interventions: (1) NIDA’s standard intervention (SI); (2) SI plus a well woman exam (WWE); and (3) SI, WWE, plus four educational sessions (4ES). Trial results indicate that 4ES was cost-effective relative to WWE, which was dominated by SI, for most diseases. Model estimates, however, suggest that WWE was cost-effective relative to SI and dominated 4ES for all diseases. Trial and model results agree that WWE is cost-effective relative to SI per hepatitis C infection averted ($109 308 for in trial, $6 016 in model) and per gonorrhea infection averted ($9 461 in trial, $14 044 in model). In sensitivity analysis, trial results are sensitive to 5 % change in WWE effectiveness relative to SI for hepatitis C and HIV. In the model, WWE remained cost-effective or cost-saving relative to SI for HIV prevention across a range of assumptions. WWE is cost-effective relative to SI for preventing hepatitis C and gonorrhea. WWE may have similar effects as the costlier 4ES.

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Acknowledgments

This work was supported by the National Institutes of Health (NIH) [National Institute on Drug Abuse (NIDA) Grant R01DA11622, and K01DA01635810 to J.P.R.], and the Patrick and Catherine Weldon Donaghue Medical Research Foundation (Grant DF06-112 to J.P.R.).

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Authors and Affiliations

  1. University of Pennsylvania Perleman School of Medicine, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA

    Jennifer Prah Ruger

  2. Washington University School of Medicine, St. Louis, MO, 63110, USA

    Arbi Ben Abdallah

  3. Yale University Schools of Public Health and Medicine, New Haven, CT, USA

    Nora Y. Ng & Craig Luekens

  4. Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA

    Linda Cottler

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  1. Jennifer Prah Ruger
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Correspondence to Jennifer Prah Ruger.

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Ruger, J.P., Abdallah, A.B., Ng, N.Y. et al. Cost-Effectiveness of Interventions to Prevent HIV and STDs Among Women: A Randomized Controlled Trial. AIDS Behav 18, 1913–1923 (2014). https://doi.org/10.1007/s10461-014-0745-8

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