Country-wide distribution of the nitrile female condom (FC2) in Brazil and South Africa: a cost-effectiveness analysis

Objective: To evaluate the cost-effectiveness and potential impact of expanded female condom distribution. Design: Cost-effectiveness analysis assessing HIV infections averted annually and incremental cost per HIV infection averted for country-wide distribution of the nitrile female condom (FC2) among sexually active individuals, 15-49 years, with access to publicly distributed condoms in Brazil and South Africa. Results: In Brazil, expansion of FC2 distribution to 10% of current male condom use would avert an estimated 604 (5-95th percentiles, 412-831) HIV infections at $20683 (5-95th percentiles, 13497-29521) per infection averted. In South Africa, 9577 (5-95th percentiles, 6539-13270) infections could be averted, at $985 (5-95th percentiles, 633-1412) per infection averted. The estimated cost of treating one HIV-infected individual is $21970 (5-95th percentiles, 18369-25719) in Brazil and $1503 (5-95th percentiles, 1245-1769) in South Africa, indicating potential cost savings. The incremental cost of expanded distribution would be reduced to $8930 (5-95th percentiles, 5864-13163) per infection averted in Brazil and $374 (5-95th percentiles, 237-553) in South Africa by acquiring FC2s through a global purchasing mechanism and increasing distribution threefold. Sensitivity analyses show model estimates to be most sensitive to the estimated prevalence of sexually transmitted infections, total sexual activity, and fraction of FC2s properly used. Conclusions: Expanded distribution of FC2 in Brazil and South Africa could avert substantial numbers of HIV infections at little or no net cost to donor or government agencies. FC2 may be a useful and cost-effective supplement to the male condom for preventing HIV. (c) 2006 Lippincott Williams & Wilkins.