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Using cost-effectiveness league tables to compare interventions to prevent sexual transmission of HIV

Pinkerton, Steven D.a,b; Johnson-Masotti, Ana P.a; Holtgrave, David R.b; Farnham, Paul G.b,c

Epidimiology & Social

Cost-effectiveness information is needed to help public health decision makers choose between competing HIV prevention programs. One way to organize this information is in a ‘league table’ that lists cost-effectiveness ratios for different interventions and which facilitates comparisons across interventions. Herein we propose a common outcome measure for use in HIV prevention league tables and present a preliminary league table of interventions to reduce sexual transmission of HIV in the US. Fifteen studies encompassing 29 intervention for different population groups are included in the table. Approximately half of the interventions are cost-saving (i.e. save society money, in the long run), and three-quarters are cost-effective by conventional standards. We discuss the utility of such a table for informing the HIV prevention resource allocation process and delineate some of the difficulties associated with the league table approach, especially as applied to HIV prevention cost-effectiveness analysis.

From the aCenter for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, the bDivision of HIV/AIDS Prevention: Intervention Research & Support, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, and cDepartment of Economics, Georgia State University, Atlanta, Georgia, USA.

Correspondence to Steven D. Pinkerton, PhD, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 North Summit Avenue, Milwaukee, WI 53202, USA. Tel: +1 414 456 7762; fax: +1 414 287 4206; e-mail:

Received: 26 September 2000;

revised: 19 January 2001; accepted: 25 January 2001.

Sponsorship: This research was supported by grants R01-MH55440, K02-MH01919, and P30-MH52776 from the National Institute of Mental Health, and by Intergovernmental Personnel Agreements awarded to S.D.P. and to P.G.F. by the Centers for Disease Control and Prevention.

© 2001 Lippincott Williams & Wilkins, Inc.