Background and objectives: Decisions about the dissemination of HIV interventions need to be informed by evidence of their cost-effectiveness in reducing negative health outcomes. Having previously shown the effectiveness of a single-session video-based group intervention (VOICES/VOCES) in reducing incidence of sexually transmitted diseases (STD) among male African American and Latino clients attending an urban STD clinic, this study estimates its cost-effectiveness in terms of disease averted.
Methods: Cost-effectiveness was calculated using data on effectiveness from a randomized clinical trial of the VOICES/VOCES intervention along with updated data on the costs of intervention from four replication sites. STD incidence and self-reported behavioral data were used to make estimates of reduction in HIV incidence among study participants.
Results: The average annual cost to provide the intervention to 10 000 STD clinic clients was estimated to be US$447 005, with a cost per client of US$43.30. This expenditure would result in an average of 27.69 HIV infections averted, with an average savings from averted medical costs of US$5 544 408. The number of quality adjusted life years saved averaged 387.61, with a cost per HIV infection averted of US$21 486.
Conclusions: This brief behavioral intervention was found to be feasible and cost-saving when targeted to male STD clinic clients at high risk of contracting and transmitting infections, indicating that this strategy should be considered for inclusion in HIV prevention programming.
From the aJohns Hopkins University School of Hygiene and Public Health and bEducation Development Center, Inc., Newton, Massachusetts, USA.
Received: 6 January 2000;
revised: 12 January 2001; accepted: 18 January 2001.
Sponsorship: This research was supported by the US Centers for Disease Control and Prevention and The National Institute of Mental Health Grant No. 5R29MH57217-03.
Correspondence to Michael Sweat, PhD, Johns Hopkins University School of Hygiene and Public Health, 615 North Wolfe St. Room 5507, Baltimore, MD. 21205, USA. Tel: +1 410 614 4536; fax: +1 703 995 0615; email: MSWEAT@JHSPH.EDU