Cost-effectiveness of HIV prevention interventions in Andhra Pradesh

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

India

Lalit Dandona, S G Prem Kumar, G Anil Kumar, Rakhi Dandona

BMC Health Services Research 2010, 10:117 (10 May 2010)

Information 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.

Methods: Based 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.

Results: The 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.

Conclusions: The 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.

A pdf version of the full article is available at the following url

http://www.biomedcentral.com/content/pdf/1472-6963-10-117.pdf