Threshold Analysis and Programs for Prevention of HIV Infection

BACKGROUND: Measuring the economic effectiveness of HIV-infection prevention activities poses special challenges in terms of behavioral change and health outcomes assessment. METHODS: One way to address this difficulty is to employ threshold analysis to determine a level of cost per HIV infection averted above which society would seem unwilling to pay. The authors employ a cost-utility analytic framework to determine a monetary threshold for HIV prevention programs, subject base-case results to sensitivity analyses, and apply these results to the Centers for Disease Control and Prevention's fiscal year 1993 budget for extramural HIV prevention programs. RESULTS: The monetary threshold for cost per HIV infection averted was calculated to be 417, 000 in 1993 dollars, and ranged from 185, 000 to 648, 000 depending upon the dollar amount society would be willing to pay per quality-adjusted life year gained. CONCLUSIONS: Economic evaluations of particular HIV-infection prevention activities at least can begin by determining whether their levels of effectiveness are above or below this derived monetary threshold, and refinements beyond this dichotomous evaluation can proceed as further data become available.