The economic burden of HIV in the United States in the era of highly active antiretroviral therapy: evidence of continuing racial and ethnic differences.
BACKGROUND
Assessing the economic burden of HIV/AIDS can help to quantify the effect of the epidemic on a population and assist policy makers in allocating public health resources.


OBJECTIVE
To estimate the economic burden of HIV/AIDS in the United States and provide race/ethnicity-specific estimates.


METHODS
We conducted an incidence-based cost-of-illness analysis to estimate the lifetime cost of HIV/AIDS resulting from new infections diagnosed in 2002. Data from the HIV/AIDS Reporting System of the Centers for Disease Control and Prevention were used to determine stage of disease at diagnosis and proportion of cases by race/ethnicity. Lifetime direct medical costs and mortality-related productivity losses were estimated using data on cost, life expectancy, and antiretroviral therapy (ART) use from the literature.


RESULTS
The cost of new HIV infections in the United States in 2002 is estimated at $36.4 billion, including $6.7 billion in direct medical costs and $29.7 billion in productivity losses. Direct medical costs per case were highest for whites ($180,900) and lowest for blacks ($160,400). Productivity losses per case were lowest for whites ($661,100) and highest for Hispanics ($838,000). In a sensitivity analysis, universal use of ART and more effective ART regimens decreased the overall cost of illness.


CONCLUSIONS
Direct medical costs and productivity losses of HIV/AIDS resulting from infections diagnosed in 2002 are substantial. Productivity losses far surpass direct medical costs and are disproportionately borne by minority races/ethnicities. Our analysis underscores economic benefits of more effective ART regimens and universal access to ART.
Hutchinson
Angela B
AB
Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30333, USA. ahutchinson@cdc.gov
Farnham
Paul G
PG
Dean
Hazel D
HD
Ekwueme
Donatus U
DU
del Rio
Carlos
C
Kamimoto
Laurie
L
Kellerman
Scott E
SE
D023241:Antiretroviral Therapy, Highly Active; D001213:Asian; D044383:Black People; D018791:CD4 Lymphocyte Count; D002487:Centers for Disease Control and Prevention, U.S. / Q000706:statistics & numerical data; D017281:Cost of Illness; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000208:ethnology*; D015497:HIV-1; D017048:Health Care Costs / Q000706:statistics & numerical data; D006630:Hispanic or Latino; D006801:Humans; D007198:Indians, North American; D008297:Male; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D044465:White People; D001741:Black or African American