Computer tool helps plan cost-effective strategies
Computer tool helps plan cost-effective strategies
Most important variable is HIV incidence
With hundreds of HIV interventions available, community planning groups often are at a loss for deciding which ones to use. Now a new tool will allow health departments to enter local data and determine which programs are most cost-effective.
"It’s proving to be a nice little tool," says Thomas Farley, MD, a researcher at the Tulane University School of Public Health. "It helps you to see how some interventions that have been pretty popular are 100 times less cost-effective than other interventions you never thought of."
The tool, Maximizing the Benefit: A Practical Tool for Community Planning Groups and Health Departments, was funded by the Centers for Disease Control and Prevention (CDC), and developed by Farley and the Rand Corporation. The tool will be offered to community planning groups around the country when completed sometime this spring.
In addition to measuring cost effectiveness, Maximizing the Benefit also contains a tool to help planning groups prioritize interventions based on other factors as well, such as feasibility and acceptability. The tool uses mathematical modeling that analyzes local data and weighing the score using five criteria. For example, a score is affected by the strength of evidence supporting the effectiveness of an intervention. Other factors include HIV prevalence, duration of the intervention, and program cost.
"What drives cost effectiveness more than anything is prevalence, so if you are dealing with teenagers, probably no strategy will turn out to be cost-effective," Farley says. "On the other hand, almost anything targeting gay men will prove cost-effective." For example, one strategy that is shown to be cost-effective is limiting post-test HIV counseling only to those who test positive. "Post-testing counseling on negatives just isn’t cost-effective," Farley says.
Two biological interventions shown to be effective are HIV treatment and circumcision.
"The use of these three biologic interventions are currently widespread. However, they are rarely used for the expressed purpose of preventing HIV transmission," the authors note. "The evidence that they reduce the spread of HIV infection is at least as strong as that for educational and psychological interventions, so they should be considered in the range of options when planning HIV prevention strategies."
Cost effectiveness, which the tool analyzes as both per client cost and per community cost, cannot be the only factor in making a decision for one strategy vs. the other. Yet when dollars are being cut, the tool could be the deciding factor.
"Because the cost-effectiveness estimates are imperfect, we do not advocate that these be the sole criteria for prioritizing interventions," the authors note. "Other factors, such as feasibility, scalability, replicability, and acceptability, and others that may be important in your community, should also be considered when finalizing how resources are to be allocated."
With hundreds of HIV interventions available, community planning groups often are at a loss for deciding which ones to use. Now a new tool will allow health departments to enter local data and determine which programs are most cost-effective.Subscribe Now for Access
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