Cost-effectiveness of interventions for improving adolescent sexual and reproductive health

Helpdesk Query:

What are the most cost-effective interventions in improving sexual and reproductive health (SRH) in adolescent girls? In what contexts are they likely to be most effective?

Summary:

Research on the cost-effectiveness of interventions to improve SRH for adolescents is limited. This rapid review includes research on some interventions which focus specifically on girls and some research on programmes for both boys and girls.

Three studies were identified that specifically analysed cost-effectiveness of SRH interventions for adolescents in low- and middle-income countries (see full report for references):

  • A randomised intervention in Kenya delivered teacher training on the national HIV/AIDS curriculum, which focuses on abstinence until marriage. Risk reduction strategies (such as condom use or selection of safer partners) were not discussed. It is estimated that the information campaign cost was just under US$100 per cross-generational pregnancy averted. A cost of US$653 is estimated per primary HIV infection averted among teenage girls (this does not include averted secondary infections).
  • A study in Botswana looking at secondary schooling as an HIV prevention intervention estimates cost-effectiveness ratios (CERs) of US$4,387/disability-adjusted life year (DALY) with antiretroviral therapy (ART) and US$1,703/DALY without ART. CERs less than per capita GDP (US$5,178 in this case) are deemed to be very cost-effective. The large benefits of secondary schooling beyond HIV transmission are excluded from the calculation. Education of girls is particularly important.
  • A competitive voucher scheme in Nicaragua was studied for cost-effectiveness but identified cost per sexually-transmitted infection (STI) cured rather than cost per prevention. The estimate was that the intervention cost US$118 per STI cured. Without the scheme, the cost estimate was US$200 per STI cured.

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