Lifetime cost of HIV care in France during the era of highly active antiretroviral therapy.
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.
Yazdanpanah
Yazdan
Y
Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Faculté de Médecine de Lille, France. yyazdan@yahoo.com
Goldie
Sue J
SJ
Losina
Elena
E
Weinstein
Milton C
MC
Lebrun
Thérèse
T
Paltiel
A David
AD
Seage
George R
GR
Leblanc
Garmenick
G
Ajana
Faisa
F
Kimmel
April D
AD
Zhang
Hong
H
Salamon
Roger
R
Mouton
Yves
Y
Freedberg
Kenneth A
KA
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