Cost-effectiveness of syringe exchange as an HIV prevention strategy.

OBJECTIVE: To analyze the cost-effectiveness of New York State-approved syringe exchange programs (SEPs) and estimate the cost-saving potential of these programs. DESIGN AND METHODS: The cost-effectiveness analysis used cost and process data provided by seven SEPs for the calendar year 1996 or the most recent 12-month period available at the time of the study. Alternative estimates of the number of HIV infections prevented were calculated using published data and a simplified circulation model. HIV treatment costs were taken from the literature. RESULTS: A cost-effectiveness ratio of $20,947 per HIV infection averted was calculated based on an estimated 87 HIV infections averted across the seven programs and total program costs of $1.82 million (all amounts given in US dollars). Sensitivity analyses were also performed. Using imputed costs for donated services and estimates of lifetime costs to treat an HIV infection, syringe exchange was demonstrated to be a cost-saving strategy from a societal perspective. CONCLUSIONS: This research demonstrates that syringe exchange is a cost-effective and cost-saving strategy for reducing HIV transmission.

The effects of increasing incentives on adherence to tuberculosis directly observed therapy.

SETTING: Six New York State Department of Health tuberculosis (TB) directly observed therapy (DOT) programs in public, private and community facilities in New York City. OBJECTIVE: A key feature of the TB DOT program was provision of incentives to motivate patients and increase adherence to therapy. The study hypothesis was that adherence will improve as the value of incentives increases and bonuses are added in a schedule of increasing rewards. DESIGN: The study population consisted of 365 patients in six inner city TB DOT programs. Interviews, clinical data and attendance records for 3+ years were analyzed. RESULTS: Patients who adhered (attending 80% of prescribed DOT visits each month of treatment) and those who did not were similar on seven demographic factors (e.g., age and sex), but were significantly different on clinical and social variables. Previous TB, resistance to rifampin, human immunodeficiency virus infection, psychiatric illness, homelessness, smoking and drug use were related to non-adherence. High adherence was significantly associated with fewer months in treatment (P < 0.016). Logistic regression showed that the odds that a patient would adhere to therapy were greater with increased incentives. Odds of adherence were significantly lower with rifampin resistance and psychiatric illness. CONCLUSION: Increasing incentives is associated with improved adherence to therapy in inner city TB populations.

A simple methodology to finance public health initiatives: reimbursement for tuberculosis directly observed therapy services in New York State.

New York State (NYS) used Medicaid reimbursement to create incentives for health care providers to offer directly observed therapy (DOT) services for active tuberculosis (TB) disease. This resulted in proliferation of 26 new TB DOT providers and expanded capacity for the New York City (NYC). Department of Health. As a result, over 1,200 individuals now receive DOT in NYC. The reimbursement methodology was also used for other NYS public health initiatives. It is applicable for public health initiatives elsewhere.

Application of cost-effectiveness methodology to the consideration of needlestick-prevention technology.

Data from the study of needlestick-prevention devices in 10 New York State hospitals enabled application of cost-effectiveness analysis techniques for determining relative benefits of various safety interventions. This article introduces to infection control practitioners several economic concepts related to cost-effectiveness methodology and provides two examples of how they may be applied for decision-making purposes. A critical aspect of the analysis described is the determination of a base cost of needlestick injury. By applying decision analysis to experience-based data aggregated from participating institutions, base expected cost of needlestick injury was determined to be $363.

Managerial decision-making in the laboratory.

Although managers make decisions daily, they do not always make them well. Because of the complexity of some decisions, a decision aid such as the multiattribute utility model is often helpful. This model can help a decision-maker in problem structuring, including determining the criteria on which the alternatives should be judged, how important these criteria are in relation to each other, and how well the alternatives stack up against these criteria. Finally, the model brings all this information together so that the decision-maker can make appropriate recommendations. By using a multiattribute utility model, this case study shows the applicability of the model to the decision of choosing among alternative hematologic instruments in a medical laboratory. The model, in any of its forms, is also useful for many other types of decisions. The model can be used either to help make a choice or to reinforce a choice made by other means and to help communicate the factors on which a choice was made.