Health and federal budgetary effects of increasing access to antiretroviral medications for HIV by expanding Medicaid.
OBJECTIVES. This study modeled the health and federal fiscal effects of expanding Medicaid for HIV-infected people to improve access to highly active antiretroviral therapy.


METHODS
A disease state model of the US HIV epidemic, with and without Medicaid expansion, was used. Eligibility required a CD4 cell count less than 500/mm3 or viral load greater than 10,000, absent or inadequate medication insurance, and annual income less than $10,000. Two benefits were modeled, "full" and "limited" (medications, outpatient care). Federal spending for Medicaid, Medicare, AIDS Drug Assistance Program, Supplemental Security Income, and Social Security Disability Insurance were assessed.


RESULTS
An estimated 38,000 individuals would enroll in a Medicaid HIV expansion. Over 5 years, expansion would prevent an estimated 13,000 AIDS diagnoses and 2600 deaths and add 5,816 years of life. Net federal costs for all programs are $739 million (full benefits) and $480 million (limited benefits); for Medicaid alone, the costs are $1.43 and $1.17 billion, respectively. Results were sensitive to awareness of serostatus, highly active antiretroviral therapy cost, and participation rate. Strategies for federal cost neutrality include Medicaid HIV drug price reductions as low as 9% and private insurance buy-ins.


CONCLUSIONS
Expansion of the Medicaid eligibility to increase access to antiretroviral therapy would have substantial health benefits at affordable costs.
Kahn
J G
JG
Institute for Health Policy Studies, Department of Epidemiology and Biostatistics, University of California, San Francisco 94143, USA. jgkahn@itsa.ucsf.edu
Haile
B
B
Kates
J
J
Chang
S
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D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology / Q000276:immunology; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D002017:Budgets / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D016527:Drug Costs / Q000706:statistics & numerical data*; D004608:Eligibility Determination / Q000191:economics / Q000379:methods / Q000592:standards; D006297:Health Services Accessibility / Q000191:economics*; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D008390:Markov Chains; D008484:Medicaid / Q000191:economics*; D017059:Models, Econometric; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D019562:Viral Load