THRESHOLD ANALYSIS AND PROGRAMS FOR PREVENTION OF HIV-INFECTION

Background. Measuring the economic effectiveness of HIV-infection prev ention activities poses special challenges in terms of behavioral chan ge acid health outcomes assessment. Methods. One way to address this d ifficulty 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 determin e a monetary threshold for HIV prevention programs, subject base-case results to sensitivity analyses, and apply these results to the Center s for Disease Control and Prevention's fiscal year 1993 budget for ext ramural HIV prevention programs. Results. The monetary threshold for c ost per HIV infection averted was calculated to be $417,000 in 1993 do llars, 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 thres hold, and refinements beyond this dichotomous evaluation can proceed a s further data become available.