Cost-Effectiveness Analysis of HIV Prevention and Treatment Portfolios in US Prison Settings
Author(s)
Yhesaem Park, MSc1, Lauren Cipriano, PhD2;
1Western University, Epidemiology and Biostatistics, London, ON, Canada, 2Ivey Business School, London, ON, Canada
1Western University, Epidemiology and Biostatistics, London, ON, Canada, 2Ivey Business School, London, ON, Canada
Presentation Documents
OBJECTIVES: The burden of HIV remains disproportionately high among people living in prison with HIV prevalence approximately three times higher than general population. We aimed to evaluate the cost-effectiveness of HIV prevention and treatment interventions in US prison settings.
METHODS: We developed a dynamic compartmental model to simulate HIV transmission within prisons and in general community. The model accounts for subadditivity of benefits and diseconomies of scale in intervention costs. We evaluated different levels of scaling up HIV screening and treatment, introducing condoms, needle and syringe programs (NSPs), and pre-exposure prophylaxis (PrEP), both alone and in combination. Interventions targeted high-risk incarcerated males—people who inject drugs (PWID) and/or who have sex with other men (MSM). Using a lifetime horizon and health system perspective, we estimated discounted total costs and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) of 20-year implementation of each strategy.
RESULTS: When implemented individually, inexpensive programs, such as condoms and NSPs at 50% coverage can be cost-saving compared to the status quo. Combining current levels of HIV screening and treatment with distributions of condoms, NSPs, and PrEP for 25% of the target population can be highly cost-effective (ICER <$30,000/QALY-gained). The next most cost-effective portfolio involves a moderate increase (10-25%) in all programs (ICER <$50,000/QALY-gained), followed by a portfolio of 100% HIV screening and treatment access among HIV-infected incarcerated individuals without introducing additional programs (ICER <$100,000/QALY-gained). Even though PrEP can provide more benefits, adding high coverage of PrEP into portfolios may not be cost-effective due to overlapping effects with other interventions.
CONCLUSIONS: Prison-based HIV prevention and treatment interventions could provide substantial and cost-effective health benefits to both inmates and the general population. Given a limited budget, resource allocation should prioritize distribution of condoms and NSPs, followed by more frequent HIV screening and universal ART access.
METHODS: We developed a dynamic compartmental model to simulate HIV transmission within prisons and in general community. The model accounts for subadditivity of benefits and diseconomies of scale in intervention costs. We evaluated different levels of scaling up HIV screening and treatment, introducing condoms, needle and syringe programs (NSPs), and pre-exposure prophylaxis (PrEP), both alone and in combination. Interventions targeted high-risk incarcerated males—people who inject drugs (PWID) and/or who have sex with other men (MSM). Using a lifetime horizon and health system perspective, we estimated discounted total costs and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) of 20-year implementation of each strategy.
RESULTS: When implemented individually, inexpensive programs, such as condoms and NSPs at 50% coverage can be cost-saving compared to the status quo. Combining current levels of HIV screening and treatment with distributions of condoms, NSPs, and PrEP for 25% of the target population can be highly cost-effective (ICER <$30,000/QALY-gained). The next most cost-effective portfolio involves a moderate increase (10-25%) in all programs (ICER <$50,000/QALY-gained), followed by a portfolio of 100% HIV screening and treatment access among HIV-infected incarcerated individuals without introducing additional programs (ICER <$100,000/QALY-gained). Even though PrEP can provide more benefits, adding high coverage of PrEP into portfolios may not be cost-effective due to overlapping effects with other interventions.
CONCLUSIONS: Prison-based HIV prevention and treatment interventions could provide substantial and cost-effective health benefits to both inmates and the general population. Given a limited budget, resource allocation should prioritize distribution of condoms and NSPs, followed by more frequent HIV screening and universal ART access.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE314
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Infectious Disease (non-vaccine)