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The Cost of HIV Care in the U.S.

According to a simulation model, adults who initiate potent combination antiretroviral therapy when their CD4 counts are <350 cells/mm³ can expect to live another 24.2 years, at a projected discounted lifetime cost of $385,200.

At various stages throughout the HIV epidemic, researchers have estimated the life expectancy and cost of care for infected individuals in the U.S. For example, in 1993, an HIV-infected adult with a CD4 count of 500 cells/mm³ was expected to live 6.8 years, and the lifetime cost of care was $119,000 (or $150,000 in 2004 dollars) (JAMA 1993; 270:474). With the advent of potent combination antiretroviral therapy in the mid-1990s, both life expectancy and cost of care increased. Now, researchers have provided new estimates based on current standards of care, using a well-accepted state-transition model of HIV disease. Information on utilization of medical services was based on data from patients who received primary care at one of seven HIV Research Network sites in 2001. Costs of services were derived from national databases, and medication costs were determined from 2004 average wholesale prices.

According to this simulation model, projected life expectancy is now 24.2 years for adults who initiate antiretroviral therapy at CD4 counts <350 cells/mm³, and the discounted lifetime cost per person is $385,200 (in 2004 dollars). This is equivalent to an average monthly cost of $2100, with 73% going toward the purchase of antiretroviral drugs. When patients initiate treatment at lower CD4 counts (<200 cells/mm³), estimated life expectancy and discounted cost of care are both lower (by 1.7 years and $31,100, respectively).

Comment: The cost of HIV care is comparable to the cost of treating other chronic conditions in patients with long life expectancies. However, these costs are not trivial, given that more than 1 million people in the U.S. are already living with HIV and another 40,000 are infected each year. The new estimates from this study reinforce the need for enhanced HIV prevention efforts. Each infection averted would save approximately $303,000. Notably, the survival values provided in this study are estimates for a simulated population of patients. The actual survival for an individual patient starting therapy today could be far different and is, of course, impossible to predict.

— Carlos del Rio, MD

Published in AIDS Clinical Care November 20, 2006

Citation(s):

Schackman BR et al. The lifetime cost of current human immunodeficiency virus care in the United States. Med Care 2006 Nov; 44:990-7.

• Medline abstract (Free)