New Tool Helps Determine if Plans Are Cost-Effective

A new software tool for determining the most benefit of HIV prevention planning will help health departments set priorities among the array of available interventions. Its central component is an Excel spreadsheet for entering local data, such as HIV and STD incidence rates. "It helps you to see how some interventions that have been pretty popular are 100 times less cost-effective than other interventions you never thought of," said Thomas Farley, M.D., a researcher at Tulane University's School of Public Health.

The instrument, "Maximizing the Benefit: A Practical Tool for Community Planning Groups and Health Departments" (MTB), was funded by CDC and developed by Farley and the Rand Corp. The device will be offered to community planning groups around the country when it is completed.

Besides measuring cost-effectiveness, MTB can also help prioritize interventions based on factors such as feasibility and acceptability. MTB uses mathematical modeling that analyzes local data and weights the score using five criteria. For example, a score is affected by the strength of evidence supporting the intervention's effectiveness. Other factors include HIV prevalence, intervention duration, and program cost. One HIV prevention intervention that comes out as being cost-effective is STD screening and treatment, Farley said.

Cost-effectiveness, which MTB analyzes as both per client cost and community cost, cannot be the only factor in choosing one strategy versus another. Yet when dollars are being cut, the tool could be the deciding factor. "Because cost-effectiveness estimates are imperfect, we do not advocate that these be the sole criteria for prioritizing interventions," the authors noted. "Other factors, such as feasibility, and others that may be important in your community, should also be considered when finalizing how resources are to be allocated."

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