Assessing prevention for positives: Cost-utility assessment of behavioral interventions for reducing HIV transmission

Abstract

Typical studies of HIV behavioral interventions measure relative risk reduction for HIV transmission. Here, we also consider the health benefits of such interventions on secondary transmission. In addition, a sensitivity analysis explores the potential additional benefits that may accrue if partners of those in the intervention group also adopt the risk reducing behavior. To do this, we developed an ordinary differential equation (ODE) model to analyze the cost and utility (measured in quality-adjusted life years, or QALYs) of a published behavioral HIV intervention that aims to reduce the risk of transmission from HIV-infected persons to their sexual partners. The ODE model maps measurements of behavioral risk reduction parameters, estimated from sampling, into costs and QALYs. Monte Carlo sampling was used to perform a probabilistic sensitivity analysis to quantify uncertainty in costs and QALYs due to parameter estimation error for the behavioral HIV intervention. The results suggest that the behavioral intervention is most likely to be cost-saving or, at least, cost-effective. The analysis highlights the step of converting uncertainty about estimates of mean values of parameters that are commonly reported in the literature to uncertainty about the costs and health benefits of an intervention. It also shows the potential importance of considering secondary transmission of HIV and the partial adoption of behavior change by partners of the individuals who undergo the intervention.