Prevalences of HTLV-1 Infection and Associated Risk Determinants in an Urban Population in Guinea-Bissau, West Africa

Purpose: To evaluate the cost-effectiveness of a cognitive-behavioral HIV risk reduction intervention for African-American male adolescents that has previously been shown to be effective at reducing sexual risk taking. Methods: Standard techniques of cost-utility analysis were employed. A societal perspective and a 3% discount rate were used in the main analysis. Program costs were ascertained retrospectively. A mathematical model of HIV transmission was used to translate observed changes in sexual behavior into an estimate of the number of HIV infections the intervention averted. Intervention effects were assumed to last for 1 year. For each infection averted, the corresponding savings in future HIV-related medical care costs and quality-adjusted life years (QALYs) were estimated. The overall net cost per QALY saved (cost-utility ratio) was then calculated. Sensitivity analyses were performed to assess the robustness of the main results. Results: The cost-utility ratio was approximately $57,000 U.S. per QALY saved when training costs were included, and $41,000 U.S. per QALY saved when they were excluded. The intervention appeared substantially more cost-effective when the analysis was restricted to the subgroup of participants who reported being sexually active at baseline. Assumptions about the prevalence of HIV infection and the duration of intervention effectiveness also greatly affected the cost-utility ratio. Conclusions: The HIV prevention intervention was moderately cost-effective in comparison with other health care programs. Selectively implementing the intervention in high-HIV prevalence communities and with sexually active youth can enhance cost-effectiveness.