Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India
Background: Avahan is a large-scale, HIV preventive intervention, targeting high-risk populations in south India. We assessed the cost-effectiveness of Avahan to inform global and national funding institutions who are considering investing in worldwide HIV prevention in concentrated epidemics. Meth...
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doaj-8f986136a93e41d8903d3d0d8ecff1ca2020-11-25T01:29:29ZengElsevierThe Lancet Global Health2214-109X2014-09-0129e531e54010.1016/S2214-109X(14)70277-3Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south IndiaDr. Anna Vassall, PhD0Michael Pickles, PhD1Sudhashree Chandrashekar, MBBS2Marie-Claude Boily, PhD3Govindraj Shetty, BCom4Lorna Guinness, PhD5Catherine M Lowndes, PhD6Janet Bradley, MA7Prof. Stephen Moses, MD8Prof. Michel Alary, MD9Prof. Peter Vickerman, DPhil10London School of Hygiene & Tropical Medicine, London, UKLondon School of Hygiene & Tropical Medicine, London, UKLondon School of Hygiene & Tropical Medicine, London, UKImperial College, London, UKKarnataka Health Promotion Trust, Bangalore, IndiaLondon School of Hygiene & Tropical Medicine, London, UKLondon School of Hygiene & Tropical Medicine, London, UKCentre de Recherche du CHU Universitaire de Québec, QC, CanadaKarnataka Health Promotion Trust, Bangalore, IndiaCentre de Recherche du CHU Universitaire de Québec, QC, CanadaLondon School of Hygiene & Tropical Medicine, London, UK Background: Avahan is a large-scale, HIV preventive intervention, targeting high-risk populations in south India. We assessed the cost-effectiveness of Avahan to inform global and national funding institutions who are considering investing in worldwide HIV prevention in concentrated epidemics. Methods: We estimated cost effectiveness from a programme perspective in 22 districts in four high-prevalence states. We used the UNAIDS Costing Guidelines for HIV Prevention Strategies as the basis for our costing method, and calculated effect estimates using a dynamic transmission model of HIV and sexually transmitted disease transmission that was parameterised and fitted to locally observed behavioural and prevalence trends. We calculated incremental cost-effective ratios (ICERs), comparing the incremental cost of Avahan per disability-adjusted life-year (DALY) averted versus a no-Avahan counterfactual scenario. We also estimated incremental cost per HIV infection averted and incremental cost per person reached. Findings: Avahan reached roughly 150 000 high-risk individuals between 2004 and 2008 in the 22 districts studied, at a mean cost per person reached of US$327 during the 4 years. This reach resulted in an estimated 61 000 HIV infections averted, with roughly 11 000 HIV infections averted in the general population, at a mean incremental cost per HIV infection averted of $785 (SD 166). We estimate that roughly 1 million DALYs were averted across the 22 districts, at a mean incremental cost per DALY averted of $46 (SD 10). Future antiretroviral treatment (ART) cost savings during the lifetime of the cohort exposed to HIV prevention were estimated to be more than $77 million (compared with the slightly more than $50 million spent on Avahan in the 22 districts during the 4 years of the study). Interpretation: This study provides evidence that the investment in targeted HIV prevention programmes in south India has been cost effective, and is likely to be cost saving if a commitment is made to provide ART to all that can benefit from it. Policy makers should consider funding and sustaining large-scale targeted HIV prevention programmes in India and beyond. Funding: Bill & Melinda Gates Foundation. http://www.sciencedirect.com/science/article/pii/S2214109X14702773 |
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language |
English |
format |
Article |
sources |
DOAJ |
author |
Dr. Anna Vassall, PhD Michael Pickles, PhD Sudhashree Chandrashekar, MBBS Marie-Claude Boily, PhD Govindraj Shetty, BCom Lorna Guinness, PhD Catherine M Lowndes, PhD Janet Bradley, MA Prof. Stephen Moses, MD Prof. Michel Alary, MD Prof. Peter Vickerman, DPhil |
spellingShingle |
Dr. Anna Vassall, PhD Michael Pickles, PhD Sudhashree Chandrashekar, MBBS Marie-Claude Boily, PhD Govindraj Shetty, BCom Lorna Guinness, PhD Catherine M Lowndes, PhD Janet Bradley, MA Prof. Stephen Moses, MD Prof. Michel Alary, MD Prof. Peter Vickerman, DPhil Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India The Lancet Global Health |
author_facet |
Dr. Anna Vassall, PhD Michael Pickles, PhD Sudhashree Chandrashekar, MBBS Marie-Claude Boily, PhD Govindraj Shetty, BCom Lorna Guinness, PhD Catherine M Lowndes, PhD Janet Bradley, MA Prof. Stephen Moses, MD Prof. Michel Alary, MD Prof. Peter Vickerman, DPhil |
author_sort |
Dr. Anna Vassall, PhD |
title |
Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India |
title_short |
Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India |
title_full |
Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India |
title_fullStr |
Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India |
title_full_unstemmed |
Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India |
title_sort |
cost-effectiveness of hiv prevention for high-risk groups at scale: an economic evaluation of the avahan programme in south india |
publisher |
Elsevier |
series |
The Lancet Global Health |
issn |
2214-109X |
publishDate |
2014-09-01 |
description |
Background: Avahan is a large-scale, HIV preventive intervention, targeting high-risk populations in south India. We assessed the cost-effectiveness of Avahan to inform global and national funding institutions who are considering investing in worldwide HIV prevention in concentrated epidemics.
Methods: We estimated cost effectiveness from a programme perspective in 22 districts in four high-prevalence states. We used the UNAIDS Costing Guidelines for HIV Prevention Strategies as the basis for our costing method, and calculated effect estimates using a dynamic transmission model of HIV and sexually transmitted disease transmission that was parameterised and fitted to locally observed behavioural and prevalence trends. We calculated incremental cost-effective ratios (ICERs), comparing the incremental cost of Avahan per disability-adjusted life-year (DALY) averted versus a no-Avahan counterfactual scenario. We also estimated incremental cost per HIV infection averted and incremental cost per person reached.
Findings: Avahan reached roughly 150 000 high-risk individuals between 2004 and 2008 in the 22 districts studied, at a mean cost per person reached of US$327 during the 4 years. This reach resulted in an estimated 61 000 HIV infections averted, with roughly 11 000 HIV infections averted in the general population, at a mean incremental cost per HIV infection averted of $785 (SD 166). We estimate that roughly 1 million DALYs were averted across the 22 districts, at a mean incremental cost per DALY averted of $46 (SD 10). Future antiretroviral treatment (ART) cost savings during the lifetime of the cohort exposed to HIV prevention were estimated to be more than $77 million (compared with the slightly more than $50 million spent on Avahan in the 22 districts during the 4 years of the study).
Interpretation: This study provides evidence that the investment in targeted HIV prevention programmes in south India has been cost effective, and is likely to be cost saving if a commitment is made to provide ART to all that can benefit from it. Policy makers should consider funding and sustaining large-scale targeted HIV prevention programmes in India and beyond.
Funding: Bill & Melinda Gates Foundation.
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url |
http://www.sciencedirect.com/science/article/pii/S2214109X14702773 |
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