Abstract
The present study sought to determine the cost per discounted quality-adjusted-life-year (QALY) saved by a small group workshop-format, cognitive-behavioral HIV-prevention intervention for gay men. The methodology employed was a retrospective cost-utility analysis of the behavioral intervention. The ability of the intervention to effect HIV-related behavior change was previously assessed in a randomized controlled trial. In the original trial, clients were recruited from gay bars, health department clinics, and other community settings in metropolitan area of 400,000 residents; the intervention was delivered in a medical school outreach setting. The participants were 104 gay men; 87% of the clients identified their race/ethnicity as White, 13% as ethnic minority. The experimental intervention was comprised of 12 sessions and provided HIV-related risk behavior education, self-management and sexual assertion training, and development of reliable and positive social support networks. The comparison condition was a wait-list control group. The main outcome measure in our retrospective cost-utility analysis was “cost per discounted QALY saved.” Under base case assumptions, the cost of the intervention was $24,000 (rounded to the nearest thousand). The discounted medical costs averted by preventing HIV infection were $42,000. Approximately 5.5 discounted QALYs were saved. Hence the intervention is cost-saving under base case assumptions (i.e., the cost per discounted QALY saved ratio is less than zero). The results are generally robust to changes in cost-utility analysis model parameters and assumptions. Because the intervention is cost-saving under base case assumptions, it compares favorably to other health service interventions in which society currently invests. Behavioral interventions such as the one examined here should receive serious consideration for investment by public health decision makers allocating fiscal resources for health services.
Similar content being viewed by others
REFERENCES
Brandeau, M. L., Owens, D. K., Sox, C. H., and Wachter, R. M. (1993). Screening women of childbearing age for human immunodeficiency virus: A model-based policy analysis. Management Science, 39, 72–92.
Brookmeyer, R., and Gail, M. H. (1994). AIDS epidemiology: a quantitative approach. New York: Oxford University Press. ia]Centers for Disease Control and Prevention. (1994a). HIV/AIDS Surveillance Report, 6(2), 5. ia]Centers for Disease Control and Prevention. (1994b). A practical guide to prevention effectiveness: Decision and economic analysis. Atlanta, GA: CDC, Epidemiology Program Office, Prevention Effectiveness Activity. ia]Centers for Disease Control and Prevention. (1995a). First 500,000 AIDS cases—United States, 1995. Morbidity and Mortality Weekly Report, 44, 849–853. ia]Centers for Disease Control and Prevention. (1995b). Update: Trends in AIDS among men who have sex with men—United States, 1989–1994. Morbidity and Mortality Weekly Report, 44, 401–404. ia]Centers for Disease Control and Prevention. (1995c). Facts about condoms and their use in preventing HIV infection and other STDS. Fact sheet available from the CDC National AIDS Clearinghouse, 1-800-458-5231.
Choi, K. H., and Coates, T. J. (1994). Prevention of HIV infection. AIDS, 8, 1371–1389.
Coates, T., McKusick, L., Kuno, R., and Stites, D. P. (1989). Stress-reduction training changed number of sexual partners but not immune function in men with HIV. American Journal of Public Health, 79, 885–887.
DiClemente, R. J., and Wingood, G. M. (1995). A randomized controlled trial of an HIV sexual risk-reduction intervention for young African American women. Journal of the American Medical Association, 274, 1271–1276.
Drummond, M. F., Stoddart, G. L., and Torrance, G. W. (1987). Methods for the economic evaluation of health care programmes. New York: Oxford University Press.
Fineberg, H. V. (1988). Education to prevent AIDS: Prospects and obstacles. Science, 239, 592–596.
Ganiats, T. G., and Wong, A. F. (1991). Evaluation of cost-effectiveness research: A survey of recent publications. Family Medicine, 23, 457–462.
Guinan, M. E., Farnham, P. G., and Holtgrave, D. R. (1994). Estimating the value of preventing a human immunodeficiency virus infection. American Journal of Preventive Medicine, 10, 1–4.
Holtgrave, D. R., and Kelly, J. A. (1996). The cost-effectiveness of an HIV prevention intervention for at-risk women attending an urban primary care clinic. American Journal of Public Health, 86, 1442–1445.
Holtgrave, D. R., and Qualls, N. L. (1995). Threshold analysis and HIV prevention programs. Medical Decision Making, 15, 311–317.
Holtgrave, D. R., Qualls, N. L., Curran, J. W., Valdiserri, R. O., Guinan, M. E., and Parra, W. C. (1995). An overview of the effectiveness and efficiency of HIV prevention programs. Public Health Reports, 110, 134–146.
Holtgrave, D. R., Qualls, N. L., and Graham, J. D. (1996). Economic evaluation of HIV prevention programs. Annual Review of Public Health, 17, 467–488.
Jacquez, J. A., Koopmen, J. S., Simon, C. P, and Longini, I. M. (1994). Role of the primary infection in epidemics of HIV infection in gay cohorts. Journal of the Acquired Immune Deficiency Syndromes, 7, 1169–1184.
Jemmott, J. B., III, Jemmott, L. S., and Fong, G. T. (1992). Reductions in HIV risk-associated sexual behaviors among black male adolescents: Effects of an AIDS prevention intervention. American Journal of Public Health, 82, 372–377.
Kaplan, E. H. (1990). Modeling HIV infectivity: Must sex acts be counted? Journal of the Acquired Immune Deficiency Syndromes, 3, 55–61.
Kelly, J. A., Murphy, D. A., Sikkema, K. J., and Kalichman, S. C. (1993). Psychological interventions to prevent HIV infection are urgently needed: New priorities for behavioral research in the second decade of AIDS. American Psychologist, 48, 1023–1034.
Kelly, J. A., Murphy, D. A., Washington, C. D., Wilson, T. S., Koob, J. J., Davis, D. R., Ledezma, G., and Davantes B. (1994). The effects of HIV/AIDS intervention groups for high-risk women in urban clinics. American Journal of Public Health, 84, 1918–1922.
Kelly, J. A., St. Lawrence, J. S., Hood, H. V., and Brasfield, T. L. (1989). Behavioral interventions to reduce AIDS risk activities. Journal of Consulting and Clinical Psychology, 57, 60–67.
Laupacis, A., Feeny, D., Detsky, A. S, and Tugwell, P. X. (1993). Tentative guidelines for using clinical and economic evaluations revisited. Canadian Medical Association Journal, 148, 927–929.
Owens, D. K., Nease, R. F., and Harris, R. (1993). Use of cost-effectiveness and value of information analyses to customize guidelines for specific clinical practice settings. Medical Decision Making, 13, 395 (abstract).
Pinkerton, S. D., and Abramson, P. R. (1993). Evaluating the risks: A Bernoulli process model of HIV infection and risk reduction. Evaluation Review, 17, 504–528.
Rotheram-Borus, M. J., Koopman, C., Haignere, C., and Davies, M. (1991). Reducing HIV sexual risk behaviors among run-away adolescents. Journal of the American Medical Association, 266, 1237–1241.
Tolley, G. L., Kenkel, D., and Fabian, R. (1994). Valuing Health for Policy: An economic approach. Chicago: University of Chicago Press.
Valdiserri, R. O., Lyter, D. W., Leviton, L. C., Callaham, C. M., Kingsley, L. A., and Rinaldo, C. R. (1989). AIDS prevention in homosexual and bisexual men: Results of a randomized trial evaluating two risk-reduction interventions. AIDS, 3, 21–26.
Weinstein, M. C., Graham, J. D., Siegel, J. E., and Fineberg, H. V. (1989). Cost-effectiveness analysis of AIDS prevention programs: Concepts, complications, and illustrations. In C. F. Turner, H. G. Miller, and L. E. Moses (Eds), AIDS: Sexual behavior and intravenous drug use (pp. 471–499). Washington, DC: National Academy Press.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Holtgrave, D.R., Kelly, J.A. Cost-Effectiveness of an HIV/AIDS Prevention Intervention for Gay Men. AIDS Behav 1, 173–180 (1997). https://doi.org/10.1023/B:AIBE.0000002978.57770.72
Issue Date:
DOI: https://doi.org/10.1023/B:AIBE.0000002978.57770.72