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

Song DL, Altice FL, Copenhaver MM, Long EF - PLoS ONE (2015)

Bottom Line: Total medical costs were estimated to compare the cost-effectiveness of each strategy.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+.

View Article: PubMed Central - PubMed

Affiliation: PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts, United States of America.

ABSTRACT

Aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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+.

Show MeSH

Related in: MedlinePlus

Estimated HIV Prevalence among PWID and Non-PWID.HHRP+: Holistic Health Recovery Program for HIV+; HIV: human immunodeficiency virus; OST: opioid substitution therapy; PWID: people who inject drugs; 3H+: Holistic Health for HIV.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4320073&req=5

pone.0116694.g002: Estimated HIV Prevalence among PWID and Non-PWID.HHRP+: Holistic Health Recovery Program for HIV+; HIV: human immunodeficiency virus; OST: opioid substitution therapy; PWID: people who inject drugs; 3H+: Holistic Health for HIV.

Mentions: Under the status quo, HIV prevalence among PWID was projected to reach 16.5% after 10 years (Fig. 2). Expanding OST could significantly reduce prevalence (to 14.3%), and HHRP+ and 3H+ also lowered prevalence (to 15.8% and 16.2%, respectively). Even with lower coverage levels, HHRP+ reduces prevalence to 16.0%. Combining HHRP+ or 3H+ with OST provided the greatest reduction in prevalence, reaching 14.1% and 14.2%, respectively.


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

Song DL, Altice FL, Copenhaver MM, Long EF - PLoS ONE (2015)

Estimated HIV Prevalence among PWID and Non-PWID.HHRP+: Holistic Health Recovery Program for HIV+; HIV: human immunodeficiency virus; OST: opioid substitution therapy; PWID: people who inject drugs; 3H+: Holistic Health for HIV.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4320073&req=5

pone.0116694.g002: Estimated HIV Prevalence among PWID and Non-PWID.HHRP+: Holistic Health Recovery Program for HIV+; HIV: human immunodeficiency virus; OST: opioid substitution therapy; PWID: people who inject drugs; 3H+: Holistic Health for HIV.
Mentions: Under the status quo, HIV prevalence among PWID was projected to reach 16.5% after 10 years (Fig. 2). Expanding OST could significantly reduce prevalence (to 14.3%), and HHRP+ and 3H+ also lowered prevalence (to 15.8% and 16.2%, respectively). Even with lower coverage levels, HHRP+ reduces prevalence to 16.0%. Combining HHRP+ or 3H+ with OST provided the greatest reduction in prevalence, reaching 14.1% and 14.2%, respectively.

Bottom Line: Total medical costs were estimated to compare the cost-effectiveness of each strategy.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+.

View Article: PubMed Central - PubMed

Affiliation: PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts, United States of America.

ABSTRACT

Aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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+.

Show MeSH
Related in: MedlinePlus