Cost-effectiveness of HIV prevention interventions in Andhra Pradesh state of India

Abstract

BackgroundInformation on cost-effectiveness of the range of HIV prevention interventions is a useful contributor to decisions on the best use of resources to prevent HIV. We conducted this assessment for the state of Andhra Pradesh that has the highest HIV burden in India.MethodsBased on data from a representative sample of 128 public-funded HIV prevention programs of 14 types in Andhra Pradesh, we have recently reported the number of HIV infections averted by each type of HIV prevention intervention and their cost. Using estimates of the age of onset of HIV infection, we used standard methods to calculate the cost per Disability Adjusted Life Year (DALY) saved as a measure of cost-effectiveness of each type of HIV prevention intervention.ResultsThe point estimates of the cost per DALY saved were less than US $50 for blood banks, men who have sex with men programmes, voluntary counselling and testing centres, prevention of parent to child transmission clinics, sexually transmitted infection clinics, and women sex worker programmes; between US $50 and 100 for truckers and migrant labourer programmes; more than US $100 and up to US $410 for composite, street children, condom promotion, prisoners and workplace programmes and mass media campaign for the general public. The uncertainty range around these estimates was very wide for several interventions, with the ratio of the high to the low estimates infinite for five interventions.ConclusionsThe point estimates for the cost per DALY saved from the averted HIV infections for all interventions was much lower than the per capita gross domestic product in this Indian state. While these indicative cost-effectiveness estimates can inform HIV control planning currently, the wide uncertainty range around estimates for several interventions suggest the need for more firm data for estimating cost-effectiveness of HIV prevention interventions in India.

Cost effectiveness of HIV and sexual reproductive health interventions targeting sex workers: a systematic review

“…Most studies evaluated a package of prevention or prevention and treatment interventions and around a third of the interventions integrated to the current health care system or programs on the ground (Additional file 3 ). For example, Dandona et al [ 35 ], evaluated a program consist of behaviour change, STI care, condom promotion, and creating an enabling environment components, and Fung et al [ 36 ] evaluated a strategy that includes STI treatment, peer education and condom distribution.…”

Community Mobilisation and Empowerment Interventions as Part of HIV Prevention for Female Sex Workers in Southern India: A Cost-Effectiveness Analysis

“…The high cost-effectiveness of community mobilization and empowerment found is likely to be primarily due to the underlying cost-effectiveness of HIV prevention in India [20] , [22] , [54] . The low cost of HIV prevention in India [55] , together with a sizeable impact on the HIV epidemic [29] , means that community mobilization and empowerment, as an intertwined intervention that enhances the effectiveness of the HIV prevention, has a sound basis on which to yield substantial returns from an HIV perspective.…”

“…The effect estimates from the causal pathway model for condom use at last sex with occasional clients (see Tables S1 and S2 in Appendix S1 ) were used to parameterise the fraction of increases in FSW condom use with clients associated with the CM and empowerment component of the intervention, and thus explore the impact of CM and empowerment activities on HIV infections averted using the simulated matched control groups described below. Unlike most previous exercises in modelling impact for cost-effectiveness analyses at scale in India [19] , [21] , [22] , the model used is dynamic (incorporating indirect population-level effects not captured in cohort models) and is employed within a Bayesian framework [1] , [29] to allow a better quantification of uncertainty.…”

“…For example, a recent study, modelling the potential cost-effectiveness of FSW-targeted HIV prevention in India (including impact on the general population), found an incremental cost per disability adjusted life year (DALY) averted of US$ 10 [19] for a basic package of services. Several further studies also suggest that cost-effectiveness can be achieved in practice and at a scale [20] – [22] . However, despite this clear evidence that investment in HIV prevention for FSWs is highly cost-effective in concentrated epidemic settings, the ‘added value’ of investing in the mobilisation and empowerment of FSWs as part of the HIV prevention package for key populations remains unclear.…”

Can telemedicine initiative be an effective intervention strategy for improving treatment compliance for pediatric HIV patients: Evidences on costs and improvement in treatment compliance from Maharashtra, India

“…The same study reported availability of second-line regimens will further increase survival, but their cost-effectiveness depends on their relative cost compared with first-line regimens [17]. Another study shows the point estimate for the cost per DALY saved from the averted HIV infections for all interventions was much lower than the per capita gross domestic product in Indian states[18]. Similarly, another study also estimated the cost of HIV prevention intervention for commercial sex workers and suggested the cost varied depending upon the scale (coverage and service volume indicators).…”