title: Economic evaluation of Safer Choices: a school-based human immunodeficiency virus, other sexually transmitted diseases, and pregnancy prevention program.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness and cost benefit of Safer Choices, a school-based human immunodeficiency virus, other sexually transmitted diseases, and unintended pregnancy prevention intervention for high school students.
  
  
  METHODS
  The baseline cost-effectiveness and cost benefit were derived in 4 steps: (1) estimation of intervention costs; (2) adaptation of the Bernoulli model to translate increases in condom use into cases of human immunodeficiency virus and other sexually transmitted diseases averted, and development of a model to translate increases in contraceptive use into cases of pregnancy averted; (3) translation of cases averted into medical costs and social costs averted; and (4) calculation of the net benefit of the program. Multivariable sensitivity analysis was performed to determine the robustness of the base-case results.
  
  
  RESULTS
  Under base-case assumptions, at an intervention cost of $105,243, Safer Choices achieved a 15% increase in condom use and an 11% increase in contraceptive use within 1 year among 345 sexually active students. An estimated 0.12 cases of human immunodeficiency virus, 24.37 cases of chlamydia, 2.77 cases of gonorrhea, 5.86 cases of pelvic inflammatory disease, and 18.5 pregnancies were prevented. For every dollar invested in the program, $2.65 in total medical and social costs were saved. Results of most of the scenarios remained cost saving under a wide range of model variable estimates.
  
  
  CONCLUSIONS
  The Safer Choices program is cost-effective and cost saving in most scenarios considered. School-based prevention programs of this type warrant careful consideration by policy makers and program planners. Program cost data should be routinely collected in evaluations of adolescent prevention programs.
authors.affiliation: Surveillance and Evaluation Research Branch, Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. lgw0@cdc.gov.
authors.forename: L Y
authors.initials: LY
authors.lastname: Wang
authors.forename: M
authors.initials: M
authors.lastname: Davis
authors.forename: L
authors.initials: L
authors.lastname: Robin
authors.forename: J
authors.initials: J
authors.lastname: Collins
authors.forename: K
authors.initials: K
authors.lastname: Coyle
authors.forename: E
authors.initials: E
authors.lastname: Baumler
mesh_terms: D000293:Adolescent; D002140:California / Q000453:epidemiology; D017280:Condoms / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control* / Q000706:statistics & numerical data; D011275:Pregnancy, Unwanted / Q000706:statistics & numerical data; D015397:Program Evaluation; D012572:School Health Services / Q000191:economics*; D012680:Sensitivity and Specificity; D012736:Sex Education / Q000191:economics*; D012749:Sexually Transmitted Diseases / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D013781:Texas / Q000453:epidemiology