[e-drug] Cost-effectiveness of the female condom in South Africa

[Graham Neilsen <NeilsG@health.gov.za>]

E-DRUG: Cost-effectiveness of the female condom in South Africa
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[The female condom is a cost-effective intervention according to this study.
If one takes into account that the female condom is strong enough
to be used repeatedly (after proper cleaning!), this looks like a very
essential device. Copied as fair use. NN]
 
Social Science & Medicine, Vol. 52 (1) (2001) pp. 135-148
� 2000 Elsevier Science Ltd. All rights reserved.
PII: S0277-9536(00)00282-3

Cost-effectiveness of the female condom in preventing HIV and STDs in
commercial sex workers in rural South Africa

Elliot Marseille a * emarseille@home.com, James G. Kahn b, Kelvin
Billinghurst c and Joseph Saba d

a Health Strategies International, 2 Madrone Place, Orinda, CA 94563, USA
b Department of Epidemiology and Biostatistics, AIDS Research Institute and
Institute for Health Policy Studies, University of California, San
Francisco, USA
c CDC - HIV / AIDS & STD Program, Mpumalanga Department of Health,
Nelspruit, South Africa
d Axios International, Dublin, Ireland

Abstract
We assessed the cost-effectiveness of the female condom (FC) in preventing
HIV infection and other STDs among commercial sex workers (CSWs) and their
clients in the Mpumulanga Province of South Africa. The health and economic
outcomes of current levels of male condom (MC) use in 1000 CSWs who average
25 partners per year and have an HIV prevalence of 50.3% was compared with
the expected outcomes resulting from the additional provision of FCs to
these CSWs. A simulation model calculated health and public sector cost
outcomes assuming 5 years of HIV infectivity, 1 month of syphilis and
gonorrhea infectivity, and FC use in 12% of episodes of vaginal intercourse.

Delayed infections and interactions between STDs and HIV were modeled. The
simulation was extended to non-CSWs with as few as one casual partner per
year. We conducted multiple sensitivity analyses. The program would
distribute 6000 FCs annually at a cost of $4002 and would avert 5.9 HIV, 38
syphilis, and 33 gonorrhea cases. This would save the public sector health
payer $12,090 in averted HIV/AIDS treatment costs, and $1,074 in averted
syphilis and gonorrhea treatment costs for a net saving of $9163.

Sensitivity analyses indicate that the economic findings are robust across a
wide range of values for key inputs. The program generates net savings of
$5421 if HIV prevalence in CSWs is 25% rather than 50.3% and savings of
$3591 if each CSW has an average of 10 clients per year rather than 25. A
program focusing on non-CSWs with only one casual partner would save $199.
We conclude that a well-designed FC program oriented to CSWs and other women
with casual partners is likely to be highly cost-effective and can save
public sector health funds in rural South Africa.

Keywords: AIDS; HIV-1; STD; Africa; Cost-effectiveness; Condoms
*Corresponding author. Tel.: +1-925-254-5379; fax: +1-415-820-6131
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