Holtgrave David R
Department of Behavioral Science and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, Georgia 30322, USA.
AIDS. 2005 Nov 18;19(17):2025-9. doi: 10.1097/01.aids.0000191926.62302.52.
Studies of the effectiveness of HIV prevention interventions for persons living with HIV have examined interventions with very wide variation in intensity (from single session interventions to those offered twice-weekly for 6 months); this raises questions about cost-effectiveness. Herein the question is asked: at varied (but specified) levels of HIV transmission rates and intervention effectiveness, how much money can be spent per HIV-seropositive client on HIV prevention services and still be considered cost-saving to society (in the United States)?
Standard methods of economic evaluation (threshold analysis, in particular) were used. Per-client HIV transmission rates and intervention effectiveness were specified and then allowed to vary widely. The threshold for intervention cost (as well as number of sessions per client) that could be justified on the basis of societal cost savings was then calculated.
If HIV transmissions are permanently prevented and lifetime medical costs are avoided in an HIV-seronegative partner, then monthly counseling sessions, even after high quality pre- and post-test counseling, and even at moderate levels of effectiveness, may be cost-saving to society (and at higher transmission rates and effectiveness, dozens of sessions per client could be cost-saving). If these interventions delay (but do not permanently prevent) HIV infection among HIV-seronegative partners, then the cost and number of session thresholds are substantially lower.
Even with considerable uncertainty in input parameters, an economic evaluation threshold analysis framework can yield useful insights for guiding the selection of intensity of HIV prevention services for persons living with HIV.
针对感染艾滋病毒者的艾滋病毒预防干预措施有效性研究，考察了强度差异极大的干预措施（从单次干预到每周两次、为期6个月的干预）；这引发了关于成本效益的问题。在此提出一个问题：在不同（但已明确）的艾滋病毒传播率和干预措施有效性水平下，每位艾滋病毒血清阳性患者在艾滋病毒预防服务上可花费多少钱，且仍被视为对社会（在美国）具有成本节约效益？
使用了经济评估的标准方法（特别是阈值分析）。明确了每位患者的艾滋病毒传播率和干预措施有效性，然后使其广泛变化。接着计算基于社会成本节约可证明合理的干预成本（以及每位患者的干预次数）阈值。
如果艾滋病毒传播被永久预防，且艾滋病毒血清阴性伴侣可避免终身医疗成本，那么即使在高质量的检测前和检测后咨询之后，每月的咨询疗程，即使在有效性处于中等水平时，对社会而言也可能具有成本节约效益（而在更高的传播率和有效性水平下，每位患者数十次的疗程可能具有成本节约效益）。如果这些干预措施延迟（但并非永久预防）艾滋病毒血清阴性伴侣感染艾滋病毒，那么成本和疗程阈值会大幅降低。
即使输入参数存在相当大的不确定性，经济评估阈值分析框架仍可为指导选择针对感染艾滋病毒者的艾滋病毒预防服务强度提供有用的见解。
