title: Lifetime cost of HIV care in France during the era of highly active antiretroviral therapy.
abstract: OBJECTIVE
  To estimate the treatment and health care costs of HIV infection or AIDS in France during the era of highly active antiretroviral therapy (HAART).
  
  
  METHODS
  We used a clinical database of HIV-infected patients to calculate the resource use and cost of care for different stages of HIV infection. Costs were incorporated into a computer-based, probabilistic simulation model of the natural history and treatment of HIV infection to estimate the lifetime cost of treating patients with HIV disease.
  
  
  METHODS
  A northern France HIV clinical cohort.
  
  
  METHODS
  1232 HIV-infected patients followed from January 1994 through July 1998.
  
  
  RESULTS
  In the absence of an AIDS-defining event, the average total cost of care ranged from 670 euros (1 euro=US $1.19) per person-month in the highest CD4 stratum (>500/microl) to 1060 euros per person-month in the lowest CD4 stratum (< or = 50/microl). The mean cost of care was estimated at 3370 euros per person-month during the initial months around the occurrence of an AIDS-defining event; at 1750 euros per person-month during the period spanning from 2 months after the diagnosis of specific AIDS-defining event to 1 month prior to death; and at 13010 euros per person-month in the final month prior to death. If clinical management of HIV infection began at a CD4 cell count of 378/microl, as in this cohort, the discounted lifetime cost of treating an HIV-infected French patient was estimated at 214000 euros. The undiscounted costs were 309000 euros over a projected life expectancy of 16.4 years.
  
  
  CONCLUSIONS
  The cost of HIV disease varies widely depending upon the stage of illness. These estimates of stage-specific and lifetime costs of HIV care will assist health policy planners in assessing the burden of disease in the era of HAART and projecting future resource requirements.
authors.affiliation: Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Faculté de Médecine de Lille, France. yyazdan@yahoo.com
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Goldie
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Milton C
authors.initials: MC
authors.lastname: Weinstein
authors.forename: Thérèse
authors.initials: T
authors.lastname: Lebrun
authors.forename: A David
authors.initials: AD
authors.lastname: Paltiel
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
authors.forename: Garmenick
authors.initials: G
authors.lastname: Leblanc
authors.forename: Faisa
authors.initials: F
authors.lastname: Ajana
authors.forename: April D
authors.initials: AD
authors.lastname: Kimmel
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
authors.forename: Roger
authors.initials: R
authors.lastname: Salamon
authors.forename: Yves
authors.initials: Y
authors.lastname: Mouton
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005602:France; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged