Cost-effectiveness analysis of brief and expanded evidence-based risk reduction interventions for HIV-infected people who inject drugs in the United States

• Published in: PloS one 2015-02, Vol.10 (2), p.e0116694
• Main Authors: Song, Dahye L, Altice, Frederick L, Copenhaver, Michael M, Long, Elisa F
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Antiretroviral drugs; Behavior modification; Clinical decision making; Clinical trials; Cost analysis; Cost benefit analysis; Costs and Cost Analysis; Decision making; Disease prevention; Disease transmission; Drug abuse; Drugs; Economic aspects; Economic conditions; Epidemics; Female; GDP; Gross Domestic Product; Health insurance; Health risks; Health surveillance; HIV; HIV infections; HIV Infections - complications; HIV Infections - economics; HIV Infections - epidemiology; HIV-1; Human behavior; Human immunodeficiency virus; Humans; Incidence; Infections; Intervention; Male; Medical economics; Middle Aged; Mortality; Opioids; Patients; Prevalence; Prevention; Prevention programs; Public health; Retrospective Studies; Risk factors; Risk reduction; Sexual behavior; Sexual transmission; Sexually transmitted diseases; STD; Substance-Related Disorders - complications; Substance-Related Disorders - economics; Substance-Related Disorders - epidemiology; Systematic review; United States - epidemiology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0116694

Two behavioral HIV prevention interventions for people who inject drugs (PWID) infected with HIV include the Holistic Health Recovery Program for HIV+ (HHRP+), a comprehensive evidence-based CDC-supported program, and an abbreviated Holistic Health for HIV (3H+) Program, an adapted HHRP+ version in treatment settings. We compared the projected health benefits and cost-effectiveness of both programs, in addition to opioid substitution therapy (OST), to the status quo in the U.S. A dynamic HIV transmission model calibrated to epidemic data of current US populations was created. Projected outcomes include future HIV incidence, HIV prevalence, and quality-adjusted life years (QALYs) gained under alternative strategies. Total medical costs were estimated to compare the cost-effectiveness of each strategy. Over 10 years, expanding HHRP+ access to 80% of PWID could avert up to 29,000 HIV infections, or 6% of the projected total, at a cost of $7,777/QALY gained. Alternatively, 3H+ could avert 19,000 infections, but is slightly more cost-effective ($7,707/QALY), and remains so under widely varying effectiveness and cost assumptions. Nearly two-thirds of infections averted with either program are among non-PWIDs, due to reduced sexual transmission from PWID to their partners. Expanding these programs with broader OST coverage could avert up to 74,000 HIV infections over 10 years and reduce HIV prevalence from 16.5% to 14.1%, but is substantially more expensive than HHRP+ or 3H+ alone. Both behavioral interventions were effective and cost-effective at reducing HIV incidence among both PWID and the general adult population; however, 3H+, the economical HHRP+ version, was slightly more cost-effective than HHRP+.