Cost-effectiveness of an intervention to reduce HIV/STI incidence and promote condom use among female sex workers in the Mexico-US border region.
BACKGROUND
Previous research demonstrated efficacy of a brief behavioral intervention to reduce incidence of HIV and sexually transmitted infections (STIs) among female sex workers (FSWs) in Tijuana and Ciudad Juarez, Mexico, cities on Mexico's border with the US. We assessed this intervention's cost-effectiveness.


RESULTS
A life-time Markov model was developed to estimate HIV cases prevented, changes in quality-adjusted life expectancy (QALE), and costs per additional quality-adjusted life year gained (QALY), comparing (in US$2,009) no intervention to a once-only and annual intervention. Future costs and health benefits were discounted annually at 3%. Sensitivity analyses evaluated model robustness. We found that for a hypothetical 1,000 FSWs receiving the once-only intervention, there were 33 HIV cases prevented and 5.7 months of QALE gained compared to no intervention. The additional cost per QALY gained was US$183. For FSWs receiving the intervention annually, there were 29 additional HIV cases prevented and 4.5 additional months of QALE compared to the once-only intervention. The additional cost per QALY was US$1,075. When highly active antiretroviral therapy (HAART) was included in the model, the annual intervention strategy resulted in net savings and dominated both once-only and no intervention strategies, and remained robust across extensive sensitivity analyses. Even when considering clinical benefits from HAART, ignoring added costs, the cost per QALY gained remained below three times the Mexican GDP per capita, and below established cost-effectiveness thresholds.


CONCLUSIONS
This brief intervention was shown to be cost-effective among FSWs in two Mexico-US border cities and may have application for FSWs in other resource-limited settings.


BACKGROUND
ClinicalTrials.gov NCT00338845.
Burgos
José L
JL
Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America.
Gaebler
Julia A
JA
Strathdee
Steffanie A
SA
Lozada
Remedios
R
Staines
Hugo
H
Patterson
Thomas L
TL
D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D002138:Calibration; D017280:Condoms / Q000191:economics* / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D008800:Mexico; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000191:economics / Q000517:prevention & control*; D019966:Substance-Related Disorders; D014481:United States