Cost-effectiveness of HIV prevention interventions in Andhra Pradesh state of India.
BACKGROUND
Information on cost-effectiveness of the range of HIV prevention interventions is a useful contributor to decisions on the best use of resources to prevent HIV. We conducted this assessment for the state of Andhra Pradesh that has the highest HIV burden in India.


METHODS
Based on data from a representative sample of 128 public-funded HIV prevention programs of 14 types in Andhra Pradesh, we have recently reported the number of HIV infections averted by each type of HIV prevention intervention and their cost. Using estimates of the age of onset of HIV infection, we used standard methods to calculate the cost per Disability Adjusted Life Year (DALY) saved as a measure of cost-effectiveness of each type of HIV prevention intervention.


RESULTS
The point estimates of the cost per DALY saved were less than US $50 for blood banks, men who have sex with men programmes, voluntary counselling and testing centres, prevention of parent to child transmission clinics, sexually transmitted infection clinics, and women sex worker programmes; between US $50 and 100 for truckers and migrant labourer programmes; more than US $100 and up to US $410 for composite, street children, condom promotion, prisoners and workplace programmes and mass media campaign for the general public. The uncertainty range around these estimates was very wide for several interventions, with the ratio of the high to the low estimates infinite for five interventions.


CONCLUSIONS
The point estimates for the cost per DALY saved from the averted HIV infections for all interventions was much lower than the per capita gross domestic product in this Indian state. While these indicative cost-effectiveness estimates can inform HIV control planning currently, the wide uncertainty range around estimates for several interventions suggest the need for more firm data for estimating cost-effectiveness of HIV prevention interventions in India.
Dandona
Lalit
L
Public Health Foundation of India, ISID Campus, 4 Institutional Area, Vasant Kunj, New Delhi 110070, India. lalit.dandona@phfi.org
Kumar
S G Prem
SG
Kumar
G Anil
GA
Dandona
Rakhi
R
D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007194:India; D015993:Life Tables; D008297:Male; D017063:Outcome Assessment, Health Care; D011314:Preventive Health Services / Q000191:economics* / Q000706:statistics & numerical data; D019057:Quality-Adjusted Life Years
Natl Med J India. 2003 May-Jun;16(3):126-31
12929853
Indian J Med Res. 2009 Jan;129(1):50-8
19287057
AIDS. 2009 Jan 14;23(2):233-42
19112690
BMC Health Serv Res. 2009 May 21;9:82
19457269
Lancet. 2007 Dec 1;370(9602):1811-3
18061043
BMC Public Health. 2005 Sep 24;5:98
16181491
BMC Public Health. 2009 Nov 18;9 Suppl 1:S5
19922689
AIDS. 2008 Dec;22 Suppl 5:S1-15
19098469
AIDS. 2008 Jul;22 Suppl 1:S43-9
18664952
Health Policy Plan. 2001 Sep;16(3):326-31
11527874
BMC Health Serv Res. 2005 Nov 05;5:69
16271151
BMC Health Serv Res. 2008 Jan 31;8:26
18234117
BMC Public Health. 2007 Aug 06;7:195
17683595
Health Policy. 2006 Jul;77(2):233-43
16126300
Natl Med J India. 2005 Jan-Feb;18(1):26-31
15835489