Economic Evaluation of delivering an evidence-based online HIV prevention program to MSM via direct-to-consumer marketing versus community-based organization recruitment

Sarah Munroe, Bruce R. Schackman, Krystal Madkins, Rana Saber, Kathryn MacApagal, Jocelyn Vititow, Nicholas Sweeney, Noah M. Feder, Nanette Benbow, Brian Mustanski, Benjamin P. Linas*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose:This study, conducted as part of the Keep It Up! (KIU!) 3.0 trial, compares the implementation costs of two strategies - centralized direct-to-consumer (DTC) marketing and decentralized distribution via community-based organizations (CBO) - in delivering an evidence-based online HIV prevention program.Methods:We conducted interviews and collected data to identify and quantify all costs for both delivery strategies. Costs were then categorized into start-up and ongoing (time-dependent and variable) costs and assigned dollar values based on established micro-costing protocols.Results:In the DTC arm (1,468 enrollees), the program was implemented from October 2019 through August 2022. Total ongoing costs including overhead and excluding start-up costs were $735,953, averaging $501 per participant. Start-up costs were $398,384 ($376,393 for content design and development and $21,991 for other costs), time-dependent costs were $219,177 ($149 per participant), and variable costs were $491,658 ($335 per participant). In the CBO arm (656 enrollees across 22 sites), KIU! was implemented for a two-year period between October 2019 and December 2022. Total ongoing costs including overhead and excluding start-up costs were $2,780,682 ($4,239 per participant). Start-up costs were $511,528 ($401,141 for content design and development and $110,386 for other costs), time-dependent costs were $1,926,958 ($2,937 per participant), and variable costs were $256,543 ($391 per participant).Conclusion:The DTC arm demonstrated a lower overall cost and a lower cost per participant compared to distribution via the CBO arm. Understanding these cost dynamics is pivotal for guiding decisions on program sustainability and determining funding requirements for future large-scale implementation.

Original languageEnglish (US)
Article number10.1097/QAI.0000000000003572
JournalJournal of acquired immune deficiency syndromes (1999)
DOIs
StateAccepted/In press - 2024

Funding

Funding: This study is funded by the National Institute on Drug Abuse, the National Institute of Mental Health (NIMH), and Office of the Director (OD) of the National Institutes of Health (R01MH118213). Additional support was provided by center grants from NIDA (P30DA040500) and the National Institute of Allergy and Infectious Diseases (P30AI117943) The funders had no role in the design of the study and will have no role in data collection, analysis, interpretation, or manuscript writing.

Keywords

  • Community-based organization
  • Cost analysis
  • Direct-to-consumer marketing
  • HIV prevention
  • Implementation science

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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