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The Lifetime Cost of Current Human Immunodeficiency Virus Care in the United States

Schackman, Bruce R. PhD*; Gebo, Kelly A. MD, MPH; Walensky, Rochelle P. MD, MPH‡∥; Losina, Elena PhD§; Muccio, Tammy BA; Sax, Paul E. MD; Weinstein, Milton C. PhD; Seage, George R. III ScD, MPH; Moore, Richard D. MD, MHS; Freedberg, Kenneth A. MD, MSc‡§¶

doi: 10.1097/01.mlr.0000228021.89490.2a
Original Article

Objective: We sought to project the lifetime cost of medical care for human immunodefiency virus (HIV)-infected adults using current antiretroviral therapy (ART) standards.

Methods: Medical visits and hospitalizations for any reason were from the HIV Research Network, a consortium of high-volume HIV primary care sites. HIV treatment drug regimen efficacies were from clinical guidelines and published sources; data on other drugs used were not available. In a computer simulation model, we projected HIV medical care costs in 2004 U.S. dollars.

Results: From the time of entering HIV care, per person projected life expectancy is 24.2 years, discounted lifetime cost is $385,200, and undiscounted cost is $618,900 for adults who initiate ART with CD4 cell count <350/μL. Seventy-three percent of the cost is antiretroviral medications, 13% inpatient care, 9% outpatient care, and 5% other HIV-related medications and laboratory costs. For patients who initiate ART with CD4 cell count <200/μL, projected life expectancy is 22.5 years, discounted lifetime cost is $354,100 and undiscounted cost is $567,000. Results are sensitive to drug manufacturers’ discounts, ART efficacy, and use of enfuvirtide for salvage. If costs are discounted to the time of infection, the discounted lifetime cost is $303,100.

Conclusions: Effective ART regimens have substantially improved survival and have increased the lifetime cost of HIV-related medical care in the U.S.

From the *Department of Public Health, Weill Medical College of Cornell University, New York, New York; †Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; ‡Department of Medicine and the Partners AIDS Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; §Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, Massachusetts; ¶Departments of Health Policy and Management and of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; and ∥Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts.

Supported in part by the National Institute of Allergy and Infectious Diseases (K23 AI01794, K24 AI062476, K25 AI50436, P30 AI42851 and R01 AI42006), the National Institute on Drug Abuse (K01 DA17179 and K23 DA00523), and the Agency for Healthcare Research and Quality (Contract 290-01-0012).

Presented in part at the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment, July 24–27, 2005, Rio de Janeiro, Brazil.

Reprints: Bruce R. Schackman, PhD, Assistant Professor of Public Health, Department of Public Health, Weill Medical College of Cornell University, 411 East 69th Street, New York, NY 10021. E-mail: brs2006@med.cornell.edu.

© 2006 Lippincott Williams & Wilkins, Inc.