Literature Commentary by Dr. John G. Bartlett: Cost of HIV Care, July 2007
Literature Commentary by Dr. John G. Bartlett: Cost of HIV Care, July 2007
Hutchinson AB, Farnham PG, Dean HD, et al. The economic burden of HIV in the United States in the era of highly active antiretroviral therapy: evidence of continuing racial and ethnic differences. J Acquir Immune Defic Syndr. 2006;43:451-457.
The purpose of the study was to determine the economic burden of HIV infection in the United States "to assist policy makers in allocating public health resources."
Method: Economic burden was determined by an incidence-based cost of illness to estimate the lifetime cost of HIV care based on 40,000 newly detected HIV infections diagnosed in 2002. Survival data was based on published results for patients receiving antiretroviral therapy (ART) and those not treated. Lifetime medical costs were based on 3 CD4 cell strata:
The lifetime direct medical care costs were based on published data for these 3 strata. Indirect costs were calculated for productivity losses based on the average life expectancy, and estimates for future earnings were based on earning potential for the year 2000 with a life expectancy of 75 years.
Results: The data based on CD4 cell strata used information from the estimates of 40,000 newly detected cases of HIV infection for 2002 (which has been a steady estimate since 1990) and the allocation by CD4 cell count, which has shown that approximately 56% are initially detected with a CD4 cell count < 200 cells/mcL.
The following analyses provide the data for individual patients with and without ART in Table 1 and the cumulative results for the entire population of 40,000 new infections in Table 2 . Table 2 includes medical care costs as well as productivity losses.
These results indicate that new HIV infections in the United States for 2002 had an estimated cost of $36 billion, including $6.7 billion in direct medical care and nearly $30 billion in productivity losses.
Conclusions: The authors concluded that the medical care and productivity losses of HIV disease are substantial and that the economic benefit of better ART regimens and universal access to ART is considerable.
Comment: Not emphasized in the report, but impossibly obvious, is the implied benefit for HIV prevention. Also important is the clear message that there is a substantial loss of life attributed to late detection, plus a 16-year difference in survival for those detected when the CD4 cell count was > 500 cells/mcL compared with those who had a CD4 cell count < 200 cells/mcL. Unfortunately, cost calculations based on earlier detection, an important component given the more recent Centers for Disease Control and Prevention (CDC) recommendations for opt-out testing, were not completed.
Valenti WM. Costs of HIV care: evolution and update. AIDS Reader. 2007;17:242-244.
Results of an analysis by an experienced investigator addressing the issue of HIV costs are summarized in Table 3 .
The results described above show the increases in life expectancy and lifetime cost of HIV care that are quite similar to those noted by the CDC. However, they also provide an interesting review of the relative cost in the 3 categories of antiretroviral drugs which account for 73% of the total, and the rest of the medical care costs, which total just 27%.
Hutchinson AB, Farnham PG, Dean HD, et al. The economic burden of HIV in the United States in the era of highly active antiretroviral therapy: evidence of continuing racial and ethnic differences. J Acquir Immune Defic Syndr. 2006;43:451-457.
The purpose of the study was to determine the economic burden of HIV infection in the United States "to assist policy makers in allocating public health resources."
Method: Economic burden was determined by an incidence-based cost of illness to estimate the lifetime cost of HIV care based on 40,000 newly detected HIV infections diagnosed in 2002. Survival data was based on published results for patients receiving antiretroviral therapy (ART) and those not treated. Lifetime medical costs were based on 3 CD4 cell strata:
< 199 cells/microliter (mcL);
200-500 cells/mcL; and
> 500 cells/mcL.
The lifetime direct medical care costs were based on published data for these 3 strata. Indirect costs were calculated for productivity losses based on the average life expectancy, and estimates for future earnings were based on earning potential for the year 2000 with a life expectancy of 75 years.
Results: The data based on CD4 cell strata used information from the estimates of 40,000 newly detected cases of HIV infection for 2002 (which has been a steady estimate since 1990) and the allocation by CD4 cell count, which has shown that approximately 56% are initially detected with a CD4 cell count < 200 cells/mcL.
The following analyses provide the data for individual patients with and without ART in Table 1 and the cumulative results for the entire population of 40,000 new infections in Table 2 . Table 2 includes medical care costs as well as productivity losses.
These results indicate that new HIV infections in the United States for 2002 had an estimated cost of $36 billion, including $6.7 billion in direct medical care and nearly $30 billion in productivity losses.
Conclusions: The authors concluded that the medical care and productivity losses of HIV disease are substantial and that the economic benefit of better ART regimens and universal access to ART is considerable.
Comment: Not emphasized in the report, but impossibly obvious, is the implied benefit for HIV prevention. Also important is the clear message that there is a substantial loss of life attributed to late detection, plus a 16-year difference in survival for those detected when the CD4 cell count was > 500 cells/mcL compared with those who had a CD4 cell count < 200 cells/mcL. Unfortunately, cost calculations based on earlier detection, an important component given the more recent Centers for Disease Control and Prevention (CDC) recommendations for opt-out testing, were not completed.
Valenti WM. Costs of HIV care: evolution and update. AIDS Reader. 2007;17:242-244.
Results of an analysis by an experienced investigator addressing the issue of HIV costs are summarized in Table 3 .
The results described above show the increases in life expectancy and lifetime cost of HIV care that are quite similar to those noted by the CDC. However, they also provide an interesting review of the relative cost in the 3 categories of antiretroviral drugs which account for 73% of the total, and the rest of the medical care costs, which total just 27%.
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