The lifetime cost of current human immunodeficiency virus care in the United States.
OBJECTIVE
We sought to project the lifetime cost of medical care for human immunodefiency virus (HIV)-infected adults using current antiretroviral therapy (ART) standards.


METHODS
Medical visits and hospitalizations for any reason were from the HIV Research Network, a consortium of high-volume HIV primary care sites. HIV treatment drug regimen efficacies were from clinical guidelines and published sources; data on other drugs used were not available. In a computer simulation model, we projected HIV medical care costs in 2004 U.S. dollars.


RESULTS
From the time of entering HIV care, per person projected life expectancy is 24.2 years, discounted lifetime cost is Dollars 385,200, and undiscounted cost is Dollars 618,900 for adults who initiate ART with CD4 cell count < 350/microL. Seventy-three percent of the cost is antiretroviral medications, 13% inpatient care, 9% outpatient care, and 5% other HIV-related medications and laboratory costs. For patients who initiate ART with CD4 cell count < 200/microL, projected life expectancy is 22.5 years, discounted lifetime cost is Dollars 354,100 and undiscounted cost is Dollars 567,000. Results are sensitive to drug manufacturers' discounts, ART efficacy, and use of enfuvirtide for salvage. If costs are discounted to the time of infection, the discounted lifetime cost is Dollars 303,100.


CONCLUSIONS
Effective ART regimens have substantially improved survival and have increased the lifetime cost of HIV-related medical care in the U.S.
Schackman
Bruce R
BR
Department of Public Health, Weill Medical College of Cornell University, New York, New York 10021, USA. brs2006@med.cornell.edu
Gebo
Kelly A
KA
Walensky
Rochelle P
RP
Losina
Elena
E
Muccio
Tammy
T
Sax
Paul E
PE
Weinstein
Milton C
MC
Seage
George R
GR
Moore
Richard D
RD
Freedberg
Kenneth A
KA
D017088:AIDS-Related Opportunistic Infections / Q000191:economics; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D000077560:Enfuvirtide; D005260:Female; D005544:Forecasting; D015700:HIV Envelope Protein gp41 / Q000191:economics / Q000627:therapeutic use; D023581:HIV Fusion Inhibitors / Q000191:economics / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D015497:HIV-1 / Q000235:genetics; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010045:Outpatients; D010446:Peptide Fragments / Q000191:economics / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012367:RNA, Viral / Q000032:analysis; D013997:Time Factors; D014481:United States
D044966:Anti-Retroviral Agents; D015700:HIV Envelope Protein gp41; D023581:HIV Fusion Inhibitors; D010446:Peptide Fragments; D012367:RNA, Viral; D000077560:Enfuvirtide