How HIV treatment advances affect the cost-effectiveness of prevention

Objective. The cost-effectiveness of an HIV prevention program depends, in part, on its potential to avert HIV-related medical care costs. Recent adva nces in antiretroviral therapy have made HIV/AIDS treatment both more effec tive and more costly, which might make HIV prevention either more or less c ost-effective. The objective of the present study was to explicate the rela tionship between the effectiveness and costs of HIV treatment and the cost- effectiveness of HIV prevention programs. Methods. A basic analytic framewo rk was used to compare the cost-effectiveness of HIV prevention interventio ns with respect to different HIV/AIDS medical care scenarios. Algebra was u sed to calculate a cost-effectiveness threshold that distinguishes preventi on programs that become more cost-effective when therapeutic advances simul taneously increase or decrease the cost and effectiveness of treatment from those that become less cost-effective. Recent estimates of the costs and c onsequences of combination antiretroviral therapy were used to illustrate t he calculation method. Results. The advent of combination antiretroviral th erapies for HIV has increased the cost-effectiveness of some, but not all, HIV prevention interventions. Conclusions. Whether a particular prevention program becomes more or less cost-effective as a consequence of advancement s in the medical treatment of HIV/AIDS depends upon the specific characteri stics of both the program and the therapy.