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10/18/2011     Estimating the Cost of HIV Prevention       Interventions with Demonstrated       Effectiveness in Reducing...
10/18/2011                  BackgroundHealth care planners and providers receive trainingand technical assistance from DHA...
10/18/2011                                                  Methods             Developed a simple method to estimate the ...
10/18/2011           Selection of Interventions  We selected 2 interventions each from DHAP-  recommended ILIs and GLIs to...
10/18/2011                   Selected Interventions Group-level interventions:   WILLOW-Women Involved in Life Learning fr...
10/18/2011                                   ResultsGroup-level interventions (GLI)                                       ...
10/18/2011                       LimitationsEstimated costs based on limited information provided in theliteratureWe assum...
10/18/2011                                             Thank You.                         Questions/Comments?For more info...
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Estimating the Cost of HIV Prevention Interventions with Demonstrated Effectiveness in Reducing Risky Behaviors

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Estimating the Cost of HIV Prevention Interventions with Demonstrated Effectiveness in Reducing Risky Behaviors

  1. 1. 10/18/2011 Estimating the Cost of HIV Prevention Interventions with Demonstrated Effectiveness in Reducing Risky Behaviors Ram K. Shrestha, PhD; Stephanie L. Sansom, PhD Paul G. Farnham, PhD; Arielle Lasry, PhD Prevention Modeling and Economics Team 2011 National HIV Prevention Conference August 14-17, 2011, Atlanta, GA National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention Background DHAP reviews and analyzes the literature on behavioral interventions intended to reduce HIV-related risk behaviors1 Interventions included individual-level (ILI), group-level (GLI) interventions Based on the relative strength of the scientific evidence of efficacy, DHAP recommends these interventions for adoption in various settings and populations1. Centers for Disease Control and Prevention. 2009 Compendium of Evidence-Based HIV Prevention Interventions, Division of HIV/AIDS Prevention, Atlanta, GA. (http://www.cdc.gov/hiv/topics/research/prs/evidence-based-interventions.htm, accessed: 6/30/2011) 1
  2. 2. 10/18/2011 BackgroundHealth care planners and providers receive trainingand technical assistance from DHAP to implementthese interventionsThey need information on the implementation cost ofthe interventions, but cost data are not readilyavailableResource utilization information provided in theefficacy literature can be used to estimate theintervention costs ObjectivesEstimate the cost of evidence-based behavioralinterventions based on published literatureCompare the cost of individual- and group-levelinterventions 2
  3. 3. 10/18/2011 Methods Developed a simple method to estimate the total cost (variable and fixed) of recommended behavioral interventions Variable costs: Hours of labor required to deliver each intervention, as reported in the efficacy of the interventions, and additional information provided by the authors Wage and fringe benefits of medical and public health social workers based on 2009 U.S. BLS data22. Average wage and fringe benefits of medical and public health social workers $28.94 (National Occupational Employment and Wage Estimates, Bureau of Labor Statistics, 2009) Methods Fixed costs: Based on the proportion of total cost reported in 4 published studies of similar HIV prevention interventions not included in our cost analysis Included the cost of program operation and management, such as administrative staff time, training, travel, facility overhead, and office supplies Represented 80% of the total intervention cost 3
  4. 4. 10/18/2011 Selection of Interventions We selected 2 interventions each from DHAP- recommended ILIs and GLIs to illustrate our cost analysis approach Selection based on the greatest number of health care providers receiving the training to implement the interventions Selected InterventionsIndividual-level interventions: RESPECT-brief counseling intervention HIV-negative, heterosexual, STD clinic patients 2 interactive individual counseling sessions, delivered by a trained HIV/STD counselor 462 providers completed training MIP-Modelo de Intervecion Psicomedica HIV-negative, Hispanic drug injectors 6 one-on-one counseling sessions, delivered by a registered nurse and a case manager 31 providers completed training 4
  5. 5. 10/18/2011 Selected Interventions Group-level interventions: WILLOW-Women Involved in Life Learning from Other Women HIV-positive, sexually active female clinic patients 4, 4-hour sessions over 4 weeks, delivered by 2 facilitators Small groups of 8-10 women per group 46 providers completed training SIHLE-Sistering, Informing, Healing, Living, and Empowering HIV-negative, sexually experienced African American girls 4, 4-hour sessions over 4 weeks, delivered by 3 facilitators Small groups of 10-12 girls per group 30 providers completed training ResultsIndividual-Level Interventions (ILI) Intervention RESPECT MIPNumber of individual sessions 2 6Length of session, hr 0.33 1.00Facilitators’ time per participant, hr 0.67 6.00Intervention participants 1,447 285Total intervention cost, $ $139,578 $247,420Cost per participant, $ $96 $868 5
  6. 6. 10/18/2011 ResultsGroup-level interventions (GLI) Intervention WILLOW SIHLENumber of groups 21 23Sessions per group 4.00 4.00Length of group session, hr 4.00 4.00Facilitators’ time per group, hr 32.00 48.00Participants per group session 9 11Intervention participants 192 251Total intervention cost, $ $215,125 $185,475Cost per participant, $ $514 $631 Results Intervention costs varied within and across ILIs and GLIs In ILIs, cost substantially lower in RESPECT-brief counseling intervention ($96 v. $868/participant) Shorter and fewer individual counseling sessions In GLI, costs similar in both interventions ($514 v. $631/participant) Same number and length of group sessions Simplicity of the intervention and lower cost might have led to higher demand for RESPECT-brief counseling intervention (462 providers trained) 6
  7. 7. 10/18/2011 LimitationsEstimated costs based on limited information provided in theliteratureWe assumed fixed costs comprised the same proportion oftotal costs despite the number of clients served, thus did notallow for economies of scale ConclusionsIntervention costs depend on the intensity of the intervention,in terms of number and length of sessionsEstimated costs are based on limited information provided inthe literature on variable and fixed costsCost estimates assist HIV prevention planners and providerswho implement the interventionsFuture research should compare the costs with interventioneffectiveness 7
  8. 8. 10/18/2011 Thank You. Questions/Comments?For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: http://www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position ofthe Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention 8

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