Cost-effectiveness of prevention referrals for high-risk HIV-negatives in San Francisco

• Published in: AIDS care Vol. 13; no. 5; pp. 637 - 642
• Main Authors: Heumann, K. S., Marx, R., Lawrence, S. J., Stump, D. L., Carroll, D. P., Hirozawa, A. M., Katz, M. H., Kahn, J. G.
• Format: Journal Article
• Language: English
• Published: Abingdon Taylor & Francis Group 01.10.2001; Taylor & Francis; Taylor & Francis Ltd
• Subjects: Acquired Immune Deficiency Syndrome; Adult; AIDS/HIV; Benefit cost analysis; Biological and medical sciences; Cost Containment; Cost effectiveness; Cost-Benefit Analysis; General populations; Groups; Health care; Health Care Costs; High risk; HIV; HIV Infections - economics; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Seronegativity; Human immunodeficiency virus; Humans; Incidence; Information and Referral Services; Male; Medical sciences; Needle Sharing; Prevention; Prevention and actions; Preventive Health Services - economics; Preventive maintenance; Public health. Hygiene; Public health. Hygiene-occupational medicine; Referral and Consultation - economics; Referrals; Retrospective Studies; Risk-Taking; San Francisco; San Francisco - epidemiology; San Francisco, California; Sexual Behavior; Urban Health Services - economics; USA; United States; North America; America; San Francisco; San Francisco California; USA, California; Infection; Human; Prevention; Immunopathology; Sanitary program; Financing cost; Viral disease; AIDS; Immune deficiency; Public health
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540120120063269

We retrospectively assessed the cost-effectiveness of providing prevention referrals to high-risk seronegatives at HIV test sites in San Francisco. We examined the costs and effects from the perspectives of society and the San Francisco Department of Public Health (SFDPH). Cost categories assessed included referral materials, counsellor training and time required to make referrals, prevention services and the value of client time. Effect data are drawn from a study of 289 high-risk seronegatives and the published literature, and are applied to a city-wide caseload of 6,626 high-risk seronegatives. We estimate that a city-wide programme in San Francisco averts two HIV infections per year and yields net savings to society of $43,765, with a cost to the SFDPH of $20,738 per HIV infection averted. We conclude that providing HIV prevention referrals to high-risk seronegatives receiving antibody testing imposes significant costs, but has attractive cost-effectiveness when applied to a large high-risk population.