HIV Prevention and Care Interventions are Cost-Effective or Cost-Saving Across Four U.S. Cities, Researchers Find

According to a study published in AIDS, increased HIV testing was cost-saving or cost-effective in Miami, Atlanta, Baltimore, and Los Angeles.  

The Centers for Disease Control and Prevention (CDC) states that cost-effectiveness analysis provides information on health and cost impacts of an intervention compared to an alternative intervention.

If the net costs of an intervention are positive, it would be considered as cost-effective. If they are negative, however, the intervention would be cost-saving. 

The study, which was co-authored by researchers across the U.S. and Canada, identified and estimated previously documented scale of delivery and costs for 16 evidence-based interventions from the CDC’s Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention.

Using a model calibrated for six U.S. cities, including Atlanta, Baltimore, Los Angeles, Miami, New York City and Seattle, they gathered information on HIV infections that were prevented, years of life that were gained due to preventive care, and incremental cost-effectiveness ratios for each intervention and city compared to the status quo over a 20-year time period.

Pre-exposure prophylaxis (PrEP), a Florida Drug Administration-approved medication that can prevent HIV if taken daily, for example, was cost-saving in Miami and cost-effective in Atlanta, Baltimore, and Los Angeles, specifically for high-risk men who have sex with men. They found that interventions made to improve antiretroviral therapy initiation, such as PrEP, gave greater value than other treatment engagement interventions. No single intervention, however, was projected to reduce HIV incidence by more than 10.1 percent in any city.

Emanuel Krebs, a health economist at the British Columbia (B.C.) Centre for Excellence in HIV/AIDS, served as the lead author in the study. The B.C. Centre for Excellence in HIV/AIDS is dedicated to improving the health of individuals with HIV through the development, ongoing monitoring and dissemination of comprehensive research and treatment programs for HIV and related diseases. 

Miller School of Medicine’s Daniel Feaster, associate professor of the Department of Public Health Sciences, who served as one of the co-authors, noted that "the simulation models that the B.C. Centre for Excellence in HIV/AIDS has created for each of these cities can provide valuable guidance for local public health efforts around HIV. It is important for our South Florida community that we put the Miami model to good use.”

The study noted that a combination of implementation strategies should be tailored to local epidemiological contexts to provide the most value. Complementary strategies addressing factors hindering access to HIV care will be necessary to meet targets for HIV elimination in the United States. 

"Expanding PrEP in Miami is cost-saving, which means money invested today will end up saving money in the long-run. The resources nevertheless need to be found to make this increase happen," Dr. Feaster added. 

Co-authors of the study also included researchers from the B.C. Centre for Excellence in HIV/AIDS, Simon Fraser University Faculty of Health Sciences, Weill Cornell Medical College Department of Healthcare Policy and Research, Emory University School of Medicine and Rollins School of Public Health, University of Washington Department of Medicine, John Hopkins School of Medicine and Bloomberg School of Public Health, Brown University School of Public Health, Columbia University Mailman School of Public Health, and the University of California in San Diego School of Medicine.

Written by Amanda Torres

Published on January 21, 2020