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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‡,§,#,∥∥,¶¶

doi: 10.1097/MLR.0000000000000308
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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.

*Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY

Agency for Healthcare Research and Quality, Rockville, MD

Division of General Internal Medicine

§Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA

#Center for AIDS Research, Harvard University, Cambridge, MA

**Division of Infectious Disease, Brigham and Women’s Hospital, Boston, MA

††Department of Health Policy and Management, Yale School of Public Health, New Haven, CT

‡‡Department of Health Policy and Management, Harvard School of Public Health, Boston, MA

§§Department of Epidemiology, Boston University School of Public Health, Boston, MA

∥∥Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA

¶¶Department of Biostatistics, Boston University School of Public Health, Boston, MA

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website, www.lww-medicalcare.com.

K.A.G. and E.L. contributed as senior authors.

Supported by the National Institute of Allergy and Infectious Diseases (R37 AI42006; P30 AI094189); the Agency for Healthcare Research and Quality (HHSA290201100007C); and the Health Resources and Services Administration (HHSH250201200008C).

Disclaimer: The views expressed in this paper are those of the authors. No official endorsement by DHHS, the National Institutes of Health, or the Agency for Healthcare Research and Quality is intended or should be inferred.

The authors declare no conflict of interest.

Reprints: Bruce R. Schackman, PhD, Healthcare Policy and Research, Department of Healthcare Policy and Research, Weill Cornell Medical College, 425 East 61st Street Suite 301, New York, NY 10064. E-mail: brs2006@med.cornell.edu.

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