COST-EFFECTIVENESS OF HIV-PREVENTION SKILLS TRAINING FOR MEN WHO HAVESEX WITH MEN

Objective: A previous study empirically compared the effects of two HI V-prevention interventions for men who have sex with men: (i) a safer sex lecture, and (ii) the same lecture coupled with a 1.5 h skills-tra ining group session. The skills-training intervention led to a signifi cant increase in condom use at 12-month follow-up, compared with the l ecture-only condition. The current study retrospectively assesses the incremental cost-effectiveness of skills training to determine whether it is worth the extra cost to add this component to an HIV-prevention intervention that would otherwise consist of a safer sex lecture only . Design: Standard techniques of incremental cost-utility analysis wer e employed. Methods: A societal perspective and a 5% discount rate wer e used. Cost categories assessed included: staff salary, fringe benefi ts, quality assurance, session materials, client transportation, clien t time valuation, and costs shared with other programs. A Bernoulli-pr ocess model of HIV transmission was used to estimate the number of HIV infections averted by the skills-training intervention component. For each infection averted, the discounted medical costs and quality-adju sted life years (QALY) saved were estimated. One- and multi-way sensit ivity analyses were performed to assess the robustness of base-case re sults to changes in modeling assumptions. Results: Under base-case ass umptions, the incremental cost of the skills training was less than $1 3,000 (or about $40 per person). The discounted medical costs averted by incrementally preventing HIV infections were over $170 000; more th an 21 discounted QALY were saved. The cost per QALY saved was negative , indicating cost-savings. These results are robust to changes in most modeling assumptions. However, the model is moderately sensitive to c hanges in the per-contact risk of HIV transmission. Conclusions: Under most reasonable assumptions, the incremental costs of the skills trai ning were outweighed by the medical costs saved. Thus, not only is ski lls training effective in reducing risky behavior, it is also cost-sav ing.