Cost-effectiveness of interventions to prevent HIV and STDs among women: a randomized controlled trial.
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.
University of Pennsylvania Perleman School of Medicine, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA, jenpr@upenn.edu.
Jennifer Prah
JP
Ruger
Arbi Ben
AB
Abdallah
Nora Y
NY
Ng
Craig
C
Luekens
Linda
L
Cottler
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006679:HIV Seropositivity / Q000191:economics / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D010353:Patient Education as Topic; D011314:Preventive Health Services / Q000191:economics; D011634:Public Health; D012749:Sexually Transmitted Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D015819:Substance Abuse, Intravenous / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D019966:Substance-Related Disorders / Q000191:economics / Q000453:epidemiology*; D014626:Vaginal Smears / Q000191:economics; D016387:Women's Health / Q000191:economics