Skip to main content
SpringerLink
Log in

A Method for Evaluating the Economic Efficiency of HIV Behavioral Risk Reduction Interventions

  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

To maximize the impact of public spending on HIV prevention, program managers, community planning groups, and other decision makers need accurate information on the economic efficiency (i.e., the relative balance between costs and consequences) of alternative HIV prevention strategies. This paper describes a technique for evaluating the economic efficiency of HIV behavioral risk reduction interventions within a cost–utility analytic framework. To determine the cost-effectiveness of the intervention, standardized values of the lifetime cost of treating HIV/AIDS and the number of quality-adjusted life years lost when someone becomes infected with HIV are combined with information about overall program costs and a model-based estimate of the number of infections averted by the intervention. The use of a standardized economic evaluation methodology for HIV prevention research, such as that proposed here, enhances cross-study comparability and thereby facilitates informed resource allocation decision making.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Anderson, R. M., Medley, G. F., May, R. M., and Johnson, M. Y. (1986). A preliminary study of transmission dynamics of the human immunodeficiency virus (HIV), the causative agent of AIDS. IMA Journal of Mathematics Applied in Medicine and Biology, 3, 229–263.

    Google Scholar 

  • Aral, S. O., and Peterman, T. A. (1996). Measuring outcomes of behavioural interventions for STD/HIV prevention. International Journal of STD and AIDS, 7(Suppl. 2), 30–38.

    Google Scholar 

  • Bloom, D. E., and Carliner, G. (1988). The economic impact of AIDS in the United States. Science, 239, 604–610.

    Google Scholar 

  • Bloom, D. E., and Glied, S. (1991). Benefits and costs of HIV testing. Science, 252, 1798–1804.

    Google Scholar 

  • Booth, R. E., and Watters, J. K. (1994). How effective are risk-reduction interventions targeting injecting drug users? AIDS, 8, 1515–1524.

    Google Scholar 

  • Brookmeyer, R., and Gail, M. H. (1994). AIDS epidemiology: A quantitative approach. New York: Oxford University Press.

    Google Scholar 

  • Carpenter, C. C. J., Fischl, M. A., Hammer, S. M., Hirsch, M. S., Jacobsen, D. M., Katzenstein, D. A., Montaner, J. S. G., Richman, D. D., Saag, M. S., Schooley, R. T., Thompson, M. A., Vella, S., Yeni, P. G., and Volberding, P. A. (1996). Antiretroviral therapy for HIV infection in 1996: Recommendations of an international panel. Journal of the American Medical Association, 276, 146–154.

    Google Scholar 

  • Center for Disease Control and Prevention. (1993). Supplementary guidance on HIV prevention community planning for noncompeting continuation of cooperative agreements for HIV prevention projects. Atlanta: Author.

    Google Scholar 

  • Choi, K. H., and Coates, T. J. (1994). Prevention of HIV infection. AIDS, 8, 1371–1389.

    Google Scholar 

  • Clemmer, B., and Haddix, A. C. (1996). Cost-benefit analysis. In A. C. Haddix, S. M. Teutsch, P. A. Shaffer, and D. O. Duñet (Eds.), Prevention effectiveness: A guide to decision analysis and economic evaluation (pp. 85–102). New York: Oxford University Press.

    Google Scholar 

  • Coyle, S. L., Boruch, R. F., and Turner, C. F. (Eds.). (1991). Evaluating AIDS Prevention programs. Washington, DC: National Academy Press.

    Google Scholar 

  • DeGruttola, V., Seage, G. R. III, Mayer, K. H., and Horsburgh, C. R., Jr. (1989). Infectiousness of HIV between male homosexual partners. Journal of Clinical Epidemiology, 42, 849–856.

    Google Scholar 

  • Dietz, K. (1988). On the transmission dynamics of HIV. Mathematical Biosciences, 90, 397–414.

    Google Scholar 

  • Fabian R. (1994). The Qualy approach. In G. L. Tolley, D. Kenkel, and R. Fabian (Eds.). Valuing health for policy: An economic approach (pp. 118–136). Chicago: University of Chicago Press.

    Google Scholar 

  • French, M. T., Mauskopf, J. A., Teague, J. L., and Roland, E. J. (1996). Estimating the dollar value of health outcomes from drug-abuse interventions. Medical Care, 34, 890–910.

    Google Scholar 

  • Gable, C. B., Tierce, J. C., Simison, D., Ward, D., and Motte, K. (1996). Costs of HIV+/AIDS at CD4+ counts disease stages based on treatment protocols. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 12, 413–420.

    Google Scholar 

  • Glied, S. (1996). Estimating the indirect cost of illness: An assessment of the foregone earning approach. American Journal of Public Health, 86, 1723–1728.

    Google Scholar 

  • Gold, M. R., Siegel, J. E., Russell, L. B., and Weinstein, M. C. (Eds.) (1996). Cost-effectiveness in health and medicine. New York: Oxford University Press.

    Google Scholar 

  • Gorsky, R. D., Haddix, A. C., and Shaffer, P. A. (1996). Cost of an intervention. In A. C. Haddix, S. M. Teutsch, P. A. Shaffer, and D. O. Duñet (Eds.), Prevention effectiveness: A guide to decision analysis and economic evaluation (pp. 57–75). New York: Oxford University Press.

    Google Scholar 

  • Grant, R. M., Wiley, J. A., and Winkelstein, W. (1987). Infectivity of human immunodeficiency virus: Estimates from a prospective study of homosexual men. Journal of Infectious Diseases, 156, 189–193.

    Google Scholar 

  • 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.

    Google Scholar 

  • Haddix, A. C., and Shaffer, P. A. (1996). Cost-effectiveness analysis. In A. C. Haddix, S. M. Teutsch, P. A. Shaffer, and D. O. Duñet (Eds.), Prevention effectiveness: A guide to decision analysis and economic evaluation (pp. 103–129). New York: Oxford University Press.

    Google Scholar 

  • Haddix, A. C., Teutsch, S. M., Shaffer, P. A., and Duñet, D. O. (Eds.) (1996). Prevention effectiveness: A guide to decision analysis and economic evaluation. Oxford: Oxford University Press.

    Google Scholar 

  • Hardy, A. M., Rausch, K., Echenberg, D., Morgan, W. M., and Curran, J. N. (1986). The economic impact of the first 10,000 cases of acquired immunodeficiency syndrome in the United States. Journal of the American Medical Association, 255, 209–211.

    Google Scholar 

  • Hearst, N., and Hulley, S. B. (1988). Preventing the heterosexual spread of AIDS. Journal of the American Medical Association, 259, 2428–2432.

    Google Scholar 

  • Hellinger, F. J. (1992). Forecasts of the costs of medical care for persons with HIV: 1991–1995. Inquiry, 29, 356–365.

    Google Scholar 

  • Hellinger, F. J. (1993). The lifetime cost of treating a person with HIV. Journal of the American Medical Association, 270, 474–478.

    Google Scholar 

  • Hodgson, T. A. (1994). Cost of illness in cost-effectiveness analysis: A review of the methodology. PharmacoEconomics, 6, 536–552.

    Google Scholar 

  • Holmberg, S. D. (1996). The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. American Journal of Public Health, 86, 642–654.

    Google Scholar 

  • Holtgrave, D. R., and Kelly, J. A. (1996). Preventing HIV/AIDS among high-risk urban women: The cost-effectiveness of a behavioral group intervention. American Journal of Public Health, 86, 1442–1445.

    Google Scholar 

  • Holtgrave, D. R., and Kelly, J. A. (1997). Cost-effectiveness of an HIV/AIDS prevention intervention for gay men. AIDS and Behavior, 1, 173–180.

    Google Scholar 

  • Holtgrave, D. R., Leviton, L. C., Wagstaff, D. A., and Pinkerton, S. D. (1997). Cumulative probability of HIV infection: A summary risk measure for HIV prevention intervention studies. AIDS and Behavior, 1, 169–172.

    Google Scholar 

  • Holtgrave, D. R., and Pinkerton, S. D. (in press). The cost-effectiveness of small group and community-level interventions. In D. R. Holtgrave (Ed.), Handbook of economic analysis of HIV prevention programs. New York: Plenum Press.

  • Holtgrave, D. R., and Pinkerton, S. D. (1997). Updates of cost of illness and quality of life estimates for use in economic evaluations of HIV prevention programs. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 16, 54–62.

    Google Scholar 

  • Holtgrave, D. R., Pinkerton, S. D., Jones, T. S., Lurie, P., and Vlahov, D. (1998). Cost and cost-effectiveness of increasing access to sterile syringes and needles as an HIV prevention intervention in the United States. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 18, 5133–5138.

    Google Scholar 

  • Holtgrave, D. R., and Qualls, N. L. (1995). Threshold analysis and HIV prevention programs. Medical Decision Making, 15, 311–317.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • Holtgrave, D. R., Valdiserri, R. O., Gerber, A. R., and Hinman, A. R. (1993). Human immunodeficiency virus counseling, testing, referral, and partner notification services: A cost-benefit analysis. Archives of Internal Medicine, 153, 1225–1230.

    Google Scholar 

  • Hurley, S. F., Kaldor, J. M., Gardiner, S., Carlin, J. B., Assunção, R. M., and Evans, D. B. (1996). Lifetime cost of human immunodeficiency virus-related health care. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 12, 371–378.

    Google Scholar 

  • Jacquez, J. A., Koopman, J. S., Simon, C. P., and Longini, I. M., Jr. (1994). Role of primary infection in epidemics of HIV infection in gay cohorts. Journal of Acquired Immune Deficiency Syndromes, 7, 1169–1184.

    Google Scholar 

  • Kahn, J. G., Washington, A. E., Showstack, J. A., Berlin, M., and Phillips, K. (1992). Updated estimates of the impact and cost of HIV prevention in injection drug users. Final report prepared for the Centers for Disease Control and Prevention. San Francisco: Institute for Health Policy Studies, University of California at San Francisco.

    Google Scholar 

  • Kaplan, E. H. (1990). Modeling HIV infectivity: Must sex acts be counted? Journal of Acquired Immune Deficiency Syndromes, 3, 55–61.

    Google Scholar 

  • Kaplan, R. M., and Bush, J. W. (1982). Health-related quality of life measurement for evaluation research and policy analysis. Health Psychology, 1, 61–80.

    Google Scholar 

  • 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.

    Google Scholar 

  • Kelly, J. A., St. Lawrence, J. S., Diaz, Y. E., Stevenson, L. Y., Hauth, A. C., Brasfield, T. L., Kalichman, S. C., Smith, J. E., and Andrew, M. E. (1991). HIV risk behavior reduction following intervention with key opinion leaders of population: An experimental analysis. American Journal of Public Health, 81, 168–171.

    Google Scholar 

  • La Croix, S. J., and Russo, G. (1996). A cost-benefit analysis of voluntary routine of HIV-antibody testing for hospital patients. Social Science and Medicine, 42, 1259–1272.

    Google Scholar 

  • Laupacis, A., Feeny, D., Detsky, A. S., and Tugwell, P. X. (1992). How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Canadian Medical Association Journal, 146, 473–481.

    Google Scholar 

  • Leviton, L. C., and Valdiserri, R. O. (1990). Evaluating AIDS prevention: Outcome implementation and mediating variables. Evaluation and Program Planning, 13, 55–65.

    Google Scholar 

  • McKay, N. L., and Phillips, K. M. (1991). An economic evaluation of mandatory premarital testing for HIV. Inquiry, 28, 236–248.

    Google Scholar 

  • Moreau, W., and Hager, C. J. (1993). Determining the unit cost of services: A guide for estimating the cost of services funded by the Ryan White Care Act of 1990. Washington, DC: U.S. Department of Health and Human Services.

    Google Scholar 

  • Moses, S., Plummer, F. A., Ngugi, E. N., Nagelkerke, N. J. D., Anzala, A. O., and Ndinya-Achola, J. O. (1991). Controlling HIV in Africa: Effectiveness and cost of an intervention in a high-frequency STD transmitter core group. AIDS, 5, 407–411.

    Google Scholar 

  • Over, M., and Piot, P. (1996). Human immunodeficiency virus infection and other sexually transmitted diseases in developing countries: Public health importance and priorities for resource allocation. Journal of Infectious Diseases, 174(Suppl. 2), S162–S167.

    Google Scholar 

  • 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.

    Google Scholar 

  • Padian, N. (1990). Heterosexual transmission: Infectivity and risks. In N. J. Alexander, H. L. Gabelnick, and J. M. Spieler (Eds.), Heterosexual transmission of AIDS (pp. 25–34). New York: Liss.

    Google Scholar 

  • Patrick, D. L., and Erikson, P. (1993). Health status and health policy: Quality of life in health care evaluation and resource allocation. New York: Oxford University Press.

    Google Scholar 

  • 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.

    Google Scholar 

  • Pinkerton, S. D., and Abramson, P. R. (1994). An alternative model of the reproductive rate of HIV infection: Formulation, evaluation, and implications for risk reduction interventions. Evaluation Review, 18, 371–388.

    Google Scholar 

  • Pinkerton, S. D., and Abramson, P. R. (1996). Occasional condom use and HIV risk reduction. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 13, 456–460.

    Google Scholar 

  • Pinkerton, S. D., and Abramson, P. R. (1997). Effectiveness of condoms in preventing HIV transmission. Social Science and Medicine, 44, 1303–1312.

    Google Scholar 

  • Pinkerton, S. D., and Abramson, P. R. (in press). The Bernoulli-process model of HIV transmission: Applications and implications. In D. R. Holtgrave (Ed.), Handbook of economic analysis of HIV prevention programs. New York: Plenum Press.

  • Pinkerton, S. D., and Holtgrave, D. R. (1997). Lifetime costs of HIV/AIDS medical care. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 14, 380–382.

    Google Scholar 

  • Pinkerton, S. D., Holtgrave, D. R., DiFranceisco, W. J., Stevenson, L. Y., and Kelly, J. A. (in press-b). Cost-effectiveness of a community-level HIV risk reduction intervention. American Journal of Public Health.

  • Pinkerton, S. D., Holtgrave, D. R., DiFranceisco, W. J., Stevenson, L. Y., and Kelly, J. A. (in press-c). Cost-effectiveness of a comunity-level HIV prevention intervention research trial. In D. R. Holtgrave (Ed.), Handbook od economic analysis of HIV prevention programs. New York: Plenum Press.

  • Pinkerton, S. D., Holtgrave, D. R., Leviton, L. C., Wagstaff, D. A., and Abramson, P. R. (1998). Model-based evaluation of HIV prevention interventions. Evaluation Review, 22, 155–174.

    Google Scholar 

  • Pinkerton, S. D., Holtgrave, D. R., Leviton, L. C., Wagstaff, D. A., Cecil, H., and Abramson, P. R. (in press-a). Toward a standardized minimum sexual behavior data set for HIV prevention interventions. American Journal of Health Behavior.

  • Pinkerton, S. D., Holtgrave, D. R., and Valdiserri, R. O. (1997). Cost-effectiveness of HIV prevention skills training for men who have sex with men. AIDS, 11, 347–357.

    Google Scholar 

  • Reiss, I. L., and Leik, R. K. (1989). Evaluating strategies to avoid AIDS: Number of partners vs. use of condoms. Journal of Sex Research, 26, 411–433.

    Google Scholar 

  • Rice, D. P. (1967). Estimating the cost of illness. American Journal of Public Health, 57, 424–440.

    Google Scholar 

  • Rice, D. P., and Max, W. (1996). Appendix I: Productivity loss tables. In A. C. Haddix, S. M. Teutsch, P. A. Shaffer, and D. O. Duñet (Eds.), Prevention effectiveness: A guide to decision analysis and economic evaluation (pp. 187–192). New York: Oxford University Press.

    Google Scholar 

  • Rosenberg, P. S. (1995). Scope of the AIDS epidemic in the United States. Science, 270, 1372–1375.

    Google Scholar 

  • Rowley, J. T., and Anderson, R. M. (1994). Modeling the impact and cost-effectiveness of HIV prevention efforts. AIDS, 8, 539–548.

    Google Scholar 

  • Schmid, G. P. (1995). Understanding the essentials of economic evaluation. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 10(Suppl. 4), S6–S13.

    Google Scholar 

  • Scitovsky, A. A., Cline, M., and Lee, P. R. (1986). Medical care costs of patients with AIDS in San Francisco. Journal of the American Medical Association, 256, 3101–3106.

    Google Scholar 

  • Scitovsky, A. A., and Rice, D. P. (1987). Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991. Public Health Reports, 102, 5–17.

    Google Scholar 

  • Seage, G. R., III, Landers, S., Barry, A., Groopman, J., Lamb, G., and Epstein, A. (1986). Medical care costs of AIDS in Massachusetts. Journal of the American Medical Association, 256, 3107–3109.

    Google Scholar 

  • Sisk, J. E. (1996). Economic evaluation of HIV/AIDS education and primary prevention. In The effectiveness of AIDS prevention efforts (pp. 309–341). Washington, DC: American Psychological Association Office on AIDS.

    Google Scholar 

  • Tengs, T. O., Adams, M. E., Pliskin, J. S., Safran, D. G., Siegel, J. E., Weinstein, M. C., and Graham, J. D. (1995). Five-hundred lifesaving interventions and their cost-effectiveness. Risk Analysis, 15, 369–390.

    Google Scholar 

  • 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.

    Google Scholar 

  • Weinstein, M. C., and Stason, W. B. (1977). Foundations of cost-effectiveness analysis for health and medical practices. New England Journal of Medicine, 296, 716–721.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin

    Steven D. Pinkerton & David R. Holtgrave

Authors
  1. Steven D. Pinkerton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David R. Holtgrave
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pinkerton, S.D., Holtgrave, D.R. A Method for Evaluating the Economic Efficiency of HIV Behavioral Risk Reduction Interventions. AIDS Behav 2, 189–201 (1998). https://doi.org/10.1023/A:1022133716954

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1022133716954

Search

Navigation