Cost-effectiveness of the NIMH multisite HIV prevention intervention

The objective of this study was to evaluate the cost-effectiveness of a state-of-the-art sexual-risk reduction intervention for high-risk men and women. The main intervention consisted of seven small-group sessions based on well-established principles of cognitive-behavioral therapy. This intervention was compared with a single-session video-based risk reduction intervention. The main outcome measure was the incremental cost-utility ratio, which equals the additional cost per additional quality-adjusted life year (QALY) saved by the cognitive-behavioral intervention, in comparison with the video intervention. A mathematical model of HIV transmission was used to translate reported sexual behavior changes into estimates of the number of HIV infections averted by the interventions, and associated savings in QALYs and averted HIV-related medical costs. For women, the incremental cost-utility ratio equaled $32,688 per QALY saved, which indicates that the cognitive-behavioral intervention was cost-effective compared to the video intervention. For men, the incremental cost-utility ratio was slightly negative, suggesting that the cognitive-behavioral intervention was highly cost-effective, or even cost-saving, compared to the video intervention. This analysis indicates that both brief and intensive sexual risk reduction interventions for high-risk populations can be cost-effective.