HIV prevention cost-effectiveness: a systematic review

Galárraga, Omar; Colchero, M. Arantxa; Wamai, Richard G.; Bertozzi, Stefano M.
January 2009
BMC Public Health;2009 Supplement 1, Vol. 9, Special section p1
Academic Journal
Background: After more than 25 years, public health programs have not been able to sufficiently reduce the number of new HIV infections. Over 7,000 people become infected with HIV every day. Lack of convincing evidence of cost-effectiveness (CE) may be one of the reasons why implementation of effective programs is not occurring at sufficient scale. This paper identifies, summarizes and critiques the CE literature related to HIV-prevention interventions in low- and middle-income countries during 2005-2008. Methods: Systematic identification of publications was conducted through several methods: electronic databases, internet search of international organizations and major funding/implementing agencies, and journal browsing. Inclusion criteria included: HIV prevention intervention, year for publication (2005-2008), setting (low- and middle-income countries), and CE estimation (empirical or modeling) using outcomes in terms of cost per HIV infection averted and/or cost per disability-adjusted life year (DALY) or quality-adjusted life year (QALY). Results: We found 21 distinct studies analyzing the CE of HIV-prevention interventions published in the past four years (2005-2008). Seventeen CE studies analyzed biomedical interventions; only a few dealt with behavioral and environmental/structural interventions. Sixteen studies focused on sub-Saharan Africa, and only a handful on Asia, Latin America and Eastern Europe. Many HIV-prevention interventions are very cost effective in absolute terms (using costs per DALY averted), and also in country-specific relative terms (in cost per DALY measured as percentage of GDP per capita). Conclusion: There are several types of interventions for which CE studies are still not available or insufficient, including surveillance, abstinence, school-based education, universal precautions, prevention for positives and most structural interventions. The sparse CE evidence available is not easily comparable; thus, not very useful for decision making. More than 25 years into the AIDS epidemic and billions of dollars of spending later, there is still much work to be done both on costs and effectiveness to adequately inform HIV prevention planning.


Related Articles

  • Cost-Effectiveness of School Support for Orphan Girls to Prevent HIV Infection in Zimbabwe. Miller, Ted; Hallfors, Denise; Cho, Hyunsan; Luseno, Winnie; Waehrer, Geetha // Prevention Science;Oct2013, Vol. 14 Issue 5, p503 

    This cost-effectiveness study analyzes the cost per quality-adjusted life year (QALY) gained in a randomized controlled trial that tested school support as a structural intervention to prevent HIV risk factors among Zimbabwe orphan girl adolescents. The intervention significantly reduced early...

  • Is the US AIDS Drug Assistance Program Cost-effective? Pinkerton, Steven; Kibicho, Jennifer; Galletly, Carol // AIDS & Behavior;Jan2013, Vol. 17 Issue 1, p1 

    Each year, the US AIDS drug assistance program (ADAP) provides access to prescription drugs-including antiretrovirals-to more than 110,000 persons living with HIV (PLWH) who lack adequate medical insurance. PLWH on effective antiretroviral therapy live longer lives, with enhanced quality of...

  • Achieving Allocative Efficiency in Healthcare: Nice in Theory, not so NICE in Practice? Paulden, Mike; McCabe, Christopher; Karnon, Jonathan // PharmacoEconomics;Apr2014, Vol. 32 Issue 4, p315 

    The authors reflect on the article by S. Eckermann and B. Pekarsky which challenges several concepts including the methods of determining cost-effectiveness threshold for assessing the potential health technology in public healthcare system. They discuss the National Institute forHealth and Care...

  • Cost-Effectiveness of a Package of Interventions for Expedited Antiretroviral Therapy Initiation During Pregnancy in Cape Town, South Africa. Zulliger, Rose; Black, Samantha; Holtgrave, David; Ciaranello, Andrea; Bekker, Linda-Gail; Myer, Landon // AIDS & Behavior;Apr2014, Vol. 18 Issue 4, p697 

    Initiating antiretroviral therapy (ART) early in pregnancy is an important component of effective interventions to prevent the mother-to-child transmission of HIV (PMTCT). The rapid initiation of ART in pregnancy (RAP) program was a package of interventions to expedite ART initiation in pregnant...

  • The value of the $50 000 per QALY threshold.  // PharmacoEconomics & Outcomes News;Sep2014, Vol. 711 Issue 1, p9 

    The article reflects on the value of the $50,000 per quality-adjusted life year (QALY) threshold in the U.S. for assessing the cost-effectiveness of an intervention.

  • How to combat HIV/AIDS: Recommendations for the Government.  // ICPS Newsletter;9/10/2007, Vol. 376 Issue 29, p1 

    The article discusses government recommendations that identify the areas that need improvement in terms of developing, implementing and monitoring HIV/AIDS policy in Ukraine. Report says that Ukraine continues to be in first place in Europe in terms of the incidence of HIV/AIDS and the pace of...

  • Government of Madagascar recognized for aggressive fight for HIV/AIDS prevention.  // Infectious Disease News;Jan2008, Vol. 21 Issue 1, p18 

    The article focuses on the aggressive public health campaign of the government of Madagascar for HIV/AIDS prevention. The country's response to HIV/AIDS has been one of the most aggressive in Africa and could serve as a model for transmission prevention and public health initiative. The coverage...

  • Governments as facilitators or obstacles in the HIV epidemic. Ammann, Arthur J; Nogueira, Susie // BMJ: British Medical Journal (International Edition);01/26/2002, Vol. 324 Issue 7331, p184 

    Editorial. Discusses the role of governments in implementing public health plans to prevent the spread of HIV infection. Need for activism to keep public health issues in the political forefront; Importance of government acknowledgement of the severity of the AIDS epidemic and a commitment to...

  • Frontline defence against HIV/Aids. Grawitzky, Renee // Finance Week;10/20/2003, p83 

    Reports that public servants in South Africa must be involved in all phases of planning and implementing the fight against HIV/AIDS. Importance of partnership and cooperation between management, unions and employees in working against HIV/AIDS; Management structure of government agencies in the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics