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  22nd Conference on Retroviruses and
Opportunistic Infections
Seattle Washington Feb 23 - 26, 2015
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Preventing one HIV infection in US saves $229,800 in modeling analysis
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CROI 2015, February 23-26, 2015, Seattle, Washington
Mark Mascolini
Preventing one HIV infection in the United States saves $229,800 in lifetime medical costs, according to a modeling study by Bruce Schackman at Weill Cornell Medical College and savvy collaborators from other centers [1]. Savings exceed $338,000 in the most expensive lifetime-cost scenario modeled. The researchers published their findings online around the time of CROI [2].
HIV prevention strategies improved dramatically in the past few years, but Schackman and colleagues noted that prevention can be costly. Up-to-date estimates of medical costs saved by avoiding HIV, they observed, are needed to "reflect the reality of current HIV care in the United States, including treatments and treatment initiation practices, costs for disease management of chronic HIV disease and other chronic diseases, and inconsistent access and adherence to effective treatment."
To make such an estimate, the researchers first gauged lifetime medical costs for HIV-positive people 18 and older then subtracted estimated lifetime medical costs for similar HIV-negative people. To project discounted lifetime medical costs of people with HIV, they used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) model of HIV disease in the United States. They also used the CEPAC model to project mortality and CD4 count distribution in people with HIV. The investigators reported results as lifetime medical costs from the US healthcare system perspective discounted at 3%.
For people with HIV, Schackman and coworkers estimated lifetime medical costs with data from the HIV Research Network stratified by age, sex, race or ethnicity, HIV transmission route, and CD4 count. To calculate annual medical costs for the HIV-negative comparison group, they used data from the Medical Expenditure Panel Survey, a nationally representative survey of US households.
In the base case of a person infected with HIV at age 35, medical costs for life add up to $326,500. Antiretroviral costs make up 60% of that total, other drugs 15%, and nondrug outlays 25%. Over the same time, the researchers figured that $96,700 would be spent on medical care of a person without HIV. Subtracting $96,700 from $326,500, they reckoned a $229,800 lifetime saving from preventing HIV infection in that person.
The most expensive lifetime medical cost scenario for a person with HIV (early entry to care and no interruption in care) reached $435,200. Subtracting lifetime medical costs for a similar HIV-negative person resulted in a lifetime saving of $338,400. The least expensive lifetime cost scenario (involving reduced antiretroviral adherence) tallied $267,100. Subtracting the cost for a similar HIV-negative person yielded a lifetime saving of $170,300.
Schackman and colleagues stressed that by focusing on health system costs, their analysis offers no hint of quality of life gains or the "broader societal gains" inherent in averting HIV infection. They noted that their model does not reflect gains from avoiding HIV-related comorbidities by avoiding HIV infection. The researchers concluded that "the economic value of HIV prevention in the United States is substantial given the high cost of HIV disease treatment."
1. Schackman BR, Fleishman J, Su A, et al. The lifetime medical cost savings from preventing HIV in the United States. CROI 2015. February 23-26, 2015. Seattle, Washington. Abstract 1104.
2. Schackman BR, Fleishman JA, Su AE, et al. The lifetime medical cost savings from preventing HIV in the United States. Med Care. 2015 Feb 21. Epub ahead of print.
The Lifetime Medical Cost Savings From Preventing HIV in the United States.
Schackman, Bruce R. PhD; Fleishman, John A. PhD; Su, Amanda E. BA; Berkowitz, Bethany K. BA; Moore, Richard D. MD, MHS; Walensky, Rochelle P. MD, MPH; Becker, Jessica E. AB; Voss, Cindy MA; Paltiel, A. David PhD; Weinstein, Milton C. PhD; Freedberg, Kenneth A. MD, MSc; Gebo, Kelly A. MD, MPH; Losina, Elena PhD
Objective: Enhanced HIV prevention interventions, such as preexposure prophylaxis for high-risk individuals, require substantial investments. We sought to estimate the medical cost saved by averting 1 HIV infection in the United States.
Methods: We estimated lifetime medical costs in persons with and without HIV to determine the cost saved by preventing 1 HIV infection. We used a computer simulation model of HIV disease and treatment (CEPAC) to project CD4 cell count, antiretroviral treatment status, and mortality after HIV infection. Annual medical cost estimates for HIV-infected persons, adjusted for age, sex, race/ethnicity, and transmission risk group, were from the HIV Research Network (range, $1854-$4545/mo) and for HIV-uninfected persons were from the Medical Expenditure Panel Survey (range, $73-$628/mo). Results are reported as lifetime medical costs from the US health system perspective discounted at 3% (2012 USD).
Results: The estimated discounted lifetime cost for persons who become HIV infected at age 35 is $326,500 (60% for antiretroviral medications, 15% for other medications, 25% nondrug costs). For individuals who remain uninfected but at high risk for infection, the discounted lifetime cost estimate is $96,700.
The medical cost saved by avoiding 1 HIV infection is $229,800. The cost saved would reach $338,400 if all HIV-infected individuals presented early and remained in care. Cost savings are higher taking into account secondary infections avoided and lower if HIV infections are temporarily delayed rather than permanently avoided.
Conclusions: The economic value of HIV prevention in the United States is substantial given the high cost of HIV disease treatment.