HIV AIDS cost-effectiveness of therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Ujjwal Rastogi, MBBS ; Alejandro Lemor, M.D. [2] ; Ammu Susheela, M.D. [3]

Overview

HIV and AIDS retard economic growth by destroying human capital. Without proper nutrition, health care and medicine that is available in developed countries, large numbers of people are falling victim to AIDS. They will not only be unable to work, but will also require significant medical care. The forecast is that this will likely cause a collapse of economies and societies in the region. In some heavily infected areas, the epidemic has left behind many orphans cared for by elderly grandparents.

Cost-Effectiveness of Therapy

Cost of HIV Treatment

• Treatment accounts for the majority of cost of HIV AIDS.
• It mostly depends on the health car utilization by HIV patients.
• The costs associated with health care utilization in each disease stage are summed across all disease stages from infection to death.
• The average annual cost of HIV care in the ART era was estimated to be $19,912 (in 2006 dollars; $23,000 in 2010 dollars
• The most recent published estimate of lifetime HIV treatment costs was $367,134 (in 2009 dollars; $379,668 in 2010 dollars).

Cost of HIV Testing

Testing in Non-Health Care Settings

• Non-health care settings, such as jails/prisons, community-based organizations (CBOs), and outreach venues, are also common places to implement HIV testing programs.
• The cost per new HIV diagnosis associated with CBO-sponsored activities ranged from $10,334 to $20,413 (2010 dollars).
• Variance in the cost per new HIV diagnosis was more pronounced when evaluating HIV testing programs in jails (from $2,946 per new diagnosis in Florida jails to $30,392 in Wisconsin jails indicting difference in implementation cost.

Testing in Health Care Setting

• Several US-based studies have evaluated the cost-effectiveness of routine opt-out HIV screening in clinical settings.
• These settings included emergency departments, primary care settings, urgent care centers, and STD clinics.
• The cost per new diagnosis ranged from $1,900 to $10,000 (in 2010 dollars), and varied by setting and testing implementation strategy

HIV Survival

• The use of highly active antiretroviral therapy (HAART) since 1996 has significantly improved survival for persons infected with HIV. Schackman et al. estimated life expectancy from the time of infection to be 32.1 years from a large dataset of persons in routine outpatient care in the current treatment era.
• Using US national HIV surveillance data, another study estimated that average life expectancy after an HIV diagnosis increased from 10.5 to 22.5 years from 1996 to 2005

Annual Cost of HIV by State

• The states with highest number of new diagnoses in 2009, and thus the greatest financial burden, were Florida, California, New York, and Texas. In all, the total lifetime treatment cost for HIV based on new diagnoses in 2009 was estimated to be $16.6 billion.

State No. of New Diagnoses Total Lifetime Treatment Cost (in million) Alabama 690 $253 Alaska 21 $8 Arizona 653 $240 Arkansas 214 $79 California 4,886 $1,794 Colorado 391 $144 Connecticut 366 $134 Delaware 168 $62 District of Columbia 713 $262 Florida 5,775 $2,120 Georgia 2,073 $761 Hawaii 70 $26 Idaho 42 $15 Illinois 1,708 $627 Indiana 483 $177 Iowa 125 $46 Kansas 150 $55 Kentucky 361 $133 Louisiana 1,247 $458 Maine 57 $21 Maryland 1,400 $514 Massachusetts 484 $178 Michigan 827 $304 Minnesota 393 $144 Mississippi 559 $205 Missouri 547 $201 Montana 30 $11 Nebraska 105 $39 Nevada 386 $142 New Hampshire 43 $16 Table adapted from CDC HIV Cost-effectiveness

State No. of New Diagnoses Total Lifetime Treatment Cost (in million) New Jersey 1,252 $460 New Mexico 170 $62 New York 4,649 $1,707 North Carolina 1,719 $631 North Dakota 14 $5 Ohio 1,144 $420 Oklahoma 297 $109 Oregon 235 $86 Pennsylvania 1,736 $637 Rhode Island 123 $45 South Carolina 789 $290 South Dakota 23 $8 Tennessee 999 $367 Texas 4,291 $1,575 Utah 125 $46 Vermont 11 $4 Virginia 997 $366 Washington 557 $204 West Virginia 80 $29 Wisconsin 305 $112 Wyoming 19 $7 Subtotal 44,502 $16,338 U.S. dependent areas American Samoa 0 $0 Guam 3 $1 Northern Mariana Islands 1 $0 Puerto Rico 671 $246 U.S. Virgin Islands 25 $9 Subtotal 700 $257 Total 45,202 $16,595 Table adapted from CDC HIV Cost-effectiveness

Impact on Other Countries

Changes in life expectancy in some hard-hit African countries. Template:Legend-lineTemplate:Legend-lineTemplate:Legend-lineTemplate:Legend-lineTemplate:Legend-line

• The increased mortality in this Southern African countries will result in a smaller skilled population and labor force. This smaller labor force will be predominantly young people, with reduced knowledge and work experience leading to reduced productivity.
• An increase in workers’ time off to look after sick family members or for sick leave will also lower productivity.
• Increased mortality will also weaken the mechanisms that generate human capital and investment in people, through loss of income and the death of parents.
• AIDS seriously weakens the taxable population, reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state's finances and slower growth of the economy.
• This results in a slower growth of the tax base, an effect that will be reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans.
• On the level of the household, AIDS results in both the loss of income and increased spending on healthcare by the household.
• The income effects of this lead to spending reduction as well as a substitution effect away from education and towards healthcare and funeral spending.
• A study in Côte d'Ivoire showed that households with an HIV/AIDS patient spent twice as much on medical expenses as other households.

• UNAIDS, WHO and the United Nations Development Program have documented a correlation between the decreasing life expectancy and the lowering of gross national product in many African countries with prevalence rates of 10% or more.
• Since 1992, predictions that AIDS would slow economic growth in these countries have been published. The degree of impact depended on assumptions about the extent to which illness would be funded by savings and who would be infected.
• Conclusions reached from models of the growth trajectories of 30 sub-Saharan economies over the period 1990–2025 were that the economic growth rates of these countries would be between 0.56 and 1.47% lower.
• The impact on gross domestic product (GDP) per capita was less conclusive. However, in 2000, the rate of growth of Africa's per capita GDP was in fact reduced by 0.7% per year from 1990–1997 with a further 0.3% per year lower in countries also affected by malaria.
• The forecast now is that the growth of GDP for these countries will undergo a further reduction of between 0.5 and 2.6% per annum. However, these estimates may be an underestimate, as they do not look at the effects on output per capita.

• Many governments in sub-Saharan Africa denied that there was a problem for years, and are only now starting to work towards solutions. Underfunding is a problem in all areas of HIV prevention when compared to even conservative estimates of the problems.

• Recent research by the Overseas Development Institute (ODI) has suggested that the private sector has begun to recognize the impact of HIV/AIDS on the bottom line, both directly and indirectly.
• It is estimated that a company can generate an average return of US$3 for every US$1 invested in employee health due to a reduced absenteeism, better productivity and reduction in employee turnover.
• Many multi-national corporations (MNCs) have therefore gotten involved in HIV/AIDS initiatives of three main types: a community-based partnerships, supply chain support, and sector-based initiatives.

• The launching of the world's first official HIV/AIDS Toolkit in Zimbabwe on October 3 2006 is a product of collaborative work between the International Federation of Red Cross and Red Crescent Societies, World Health Organization and the Southern Africa HIV/AIDS Information Dissemination Service.

• It is for the strengthening of people living with HIV/AIDS and nurses by minimal external support. The package, which is in form of eight modules focusing on basic facts about HIV and AIDS, was pre-tested in Zimbabwe in March 2006 to determine its adaptability. It disposes, among other things, categorized guidelines on clinical management, education and counseling of AIDS victims at community level.

• The Copenhagen Consensus is a project that seeks to establish priorities for advancing global welfare using methodologies based on the theory of welfare economics. The participants are all economists, with the focus of the project being a rational prioritization based on economic analysis. The project is based on the contention that, in spite of the billions of dollars spent on global challenges by the United Nations, the governments of wealthy nations, foundations, charities, and non-governmental organizations, the money spent on problems such as malnutrition and climate change is not sufficient to meet many internationally-agreed targets.
• The highest priority was assigned to implementing new measures to prevent the spread of HIV and AIDS. The economists estimated that an investment of $27 billion could avert nearly 30 million new infections by 2010.