Cost-effectiveness of an intervention to reduce HIV/STI incidence and promote condom use among female sex workers in the Mexico-US border region.

José L Burgos,Hugo Staines,Remedios Lozada,Julia A Gaebler,Steffanie A Strathdee,Thomas L Patterson,Eran Bendavid

doi:10.1371/journal.pone.0011413

Abstract

BackgroundPrevious research demonstrated efficacy of a brief behavioral intervention to reduce incidence of HIV and sexually transmitted infections (STIs) among female sex workers (FSWs) in Tijuana and Ciudad Juarez, Mexico, cities on Mexico's border with the US. We assessed this intervention's cost-effectiveness.Methodology and Principal FindingsA life-time Markov model was developed to estimate HIV cases prevented, changes in quality-adjusted life expectancy (QALE), and costs per additional quality-adjusted life year gained (QALY), comparing (in US$2,009) no intervention to a once-only and annual intervention. Future costs and health benefits were discounted annually at 3%. Sensitivity analyses evaluated model robustness. We found that for a hypothetical 1,000 FSWs receiving the once-only intervention, there were 33 HIV cases prevented and 5.7 months of QALE gained compared to no intervention. The additional cost per QALY gained was US$183. For FSWs receiving the intervention annually, there were 29 additional HIV cases prevented and 4.5 additional months of QALE compared to the once-only intervention. The additional cost per QALY was US$1,075. When highly active antiretroviral therapy (HAART) was included in the model, the annual intervention strategy resulted in net savings and dominated both once-only and no intervention strategies, and remained robust across extensive sensitivity analyses. Even when considering clinical benefits from HAART, ignoring added costs, the cost per QALY gained remained below three times the Mexican GDP per capita, and below established cost-effectiveness thresholds.Conclusions/SignificanceThis brief intervention was shown to be cost-effective among FSWs in two Mexico-US border cities and may have application for FSWs in other resource-limited settings.Trial RegistrationClinicalTrials.gov NCT00338845

Highlights

The financial burden of the worldwide HIV epidemic surpasses US$10 billion annually [1], and over US$270 million annually in Mexico [2], where 88% of costs are attributable to highly active antiretroviral therapy (HAART) [3]
A Monte Carlo simulation was conducted to calculate clinical benefits and lifetime costs comparing no intervention to the Mujer Segura intervention offered once only or annually
Strategies were compared by calculating the incremental cost-effectiveness ratios (ICER), defined as the additional health benefit of an intervention compared with the least costly strategy [14]

Summary

Introduction

The financial burden of the worldwide HIV epidemic surpasses US$10 billion annually [1], and over US$270 million annually in Mexico [2], where 88% of costs are attributable to highly active antiretroviral therapy (HAART) [3]. Programs aimed at reducing HIV and STIs among FSWs are thought to be cost-effective since they reduce HIV transmission from high-risk groups to the general population in areas with concentrated epidemics [9], [10]. Previous research demonstrated efficacy of a brief behavioral intervention to reduce incidence of HIV and sexually transmitted infections (STIs) among female sex workers (FSWs) in Tijuana and Ciudad Juarez, Mexico, cities on Mexico’s border with the US.

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Conclusion