The Cost-Effectiveness of Condoms in the Prevention of HIV Infection in England and Wales: Should Condoms Be Available on Prescription?

Abstract

Objectives: HIV and AIDS represent a considerable challenge to the British National Health Service, and the resources devoted to treatment and prevention of HIV/AIDS are significant and likely to increase. The focus of recent campaigns promoting safer sexual practices to prevent the spread of HIV have focused on the use of condoms, since condom use reduces the probability of infection. Furthermore, it has also been suggested that condoms should Be provided routinely on prescription by general practitioners (GPs). The objective of this study was to evaluate the cost-effectiveness of GP-provision of condoms in the prevention of HIV infection. Since risk factors for HIV infection differ across population groups, cost-effectiveness ratios for three at-risk groups were considered. Methods: Estimates of the cost per infection prevented and the cost per life year gained were made for female heterosexuals, male heterosexuals, and male homosexuals in England and Wales. Sensitivity analysis was conducted on a number of key parameters. Results: The costs per infection prevented were £2 327 744 for female heterosexuals, £9 709 987 for male heterosexuals and £1315 for male homosexuals. The corresponding costs per life year gained were £56 774, £269 722 and £37. When savings from the costs of care were taken into account the use of condoms resulted in cost savings of nearly £50 000 for homosexual males. Conclusions: The provision of GP-prescribed condoms is highly cost-effective for male homosexuals. Such provision is much less cost-effective for heterosexuals, primarily due to the relatively low prevalence of HIV in the heterosexual population and the low infectivity parameter. This suggests that routine GP-provision of condoms would be inappropriate for all at-risk groups, and should target high-risk groups, specifically male homosexuals.