Assessment of the Cost-Effectiveness of a Brief Video Intervention for Sexually Transmitted Disease Prevention

Abstract

Background: Cost-effective, scalable interventions are needed to address high rates of sexually transmitted diseases (STDs) in the United States. Safe in the City, a 23-minute video intervention designed for STD clinic waiting rooms, effectively reduced new infections among STD clinic clients. A cost-effectiveness analysis of this type of intervention could inform whether it should be replicated.

Methods: The cost-effectiveness of a brief video intervention was calculated under a baseline scenario in which this type of intervention was expanded to a larger patient population. Alternative scenarios included expanding the intervention over a longer period or to more clinics, including HIV prevention benefits, and operating the intervention part time. Program costs, net costs per STD case averted, and the discounted net cost of the intervention were calculated from a health sector perspective across the scenarios. Monte Carlo simulations were used to calculate 95% confidence intervals surrounding the cost-effectiveness measures.

Results: The net cost per case averted was $75 in the baseline scenario. The net cost of the intervention was $108,015, and most of the alternative scenarios found that the intervention was cost saving compared with usual care.

Conclusions: Single session, video-based interventions can be highly cost effective when implemented at scale. Updated video-based interventions that account for the changing STD landscape in the United States could play an important role in addressing the recent increases in infections.

Figure 1.

Scatterplot of simulated program costs and costs averted for baseline scenario. Each dot represents 1 of 1000 random draws from the simulated data. Costs averted and program costs are with respect to having no intervention (usual care). The dotted line shows the threshold where costs averted = program costs. Values above the dotted line have a negative net cost (program costs − costs averted < 0). These values are cost saving and therefore dominate usual care. However, values below the threshold may still be considered cost-effective.