title: The Impact of State AIDS Drug Assistance Policies on Clinical and Economic Outcomes of People With HIV.
abstract: We investigated the effect of changes to state AIDS Drug Assistance Programs (ADAP) policies, which govern access to antiretroviral therapy (ART), on clinical and economic outcomes among low-income people living with HIV/AIDS. Retrospective analyses of ART access were conducted on state ADAP policies, using data from ADAP Monitoring Reports and Kaiser Family Foundation from 2006 to 2010. We found stricter eligibility requirements reduce the number of HIV-positive individuals with ART access through ADAP, and decreased ART use increases mortality by 2.67 quality-adjusted life years (QALYs) per beneficiary. If the ADAP income eligibility cutoff were decreased by 50 percentage points in each state, 4,626 individuals would lose ART access nationwide. Based on a $22,143 cost/QALY, this policy would save $274 million in health care expenditures (2012 dollars), but result in 12,352 QALYs lost, valued at $1.2 billion. Therefore, states should exercise caution in restricting programs that increase ART access for low-income people living with HIV/AIDS.
authors.affiliation: Precision Health Economics, Los Angeles, CA, USA julia.snider@pheconomics.com.
authors.forename: Julia Thornton
authors.initials: JT
authors.lastname: Snider
authors.affiliation: University of Southern California, Los Angeles, CA, USA.
authors.forename: Dana P
authors.initials: DP
authors.lastname: Goldman
authors.affiliation: Bristol-Myers Squibb, Plainsboro, NJ, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rosenblatt
authors.affiliation: Bristol-Myers Squibb, Plainsboro, NJ, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seekins
authors.affiliation: AbbVie, Chicago, IL, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Juday
authors.affiliation: AbbVie, Chicago, IL, USA.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Sanchez
authors.affiliation: Precision Health Economics, Los Angeles, CA, USA.
authors.forename: Yanyu
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Precision Health Economics, Los Angeles, CA, USA.
authors.forename: Desi
authors.initials: D
authors.lastname: Peneva
authors.affiliation: University of Southern California, Los Angeles, CA, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Romley
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D006291:Health Policy / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008483:Medical Assistance / Q000191:economics / Q000706:statistics & numerical data; D011203:Poverty; D012189:Retrospective Studies; D013219:State Government; D014481:United States
chemical_list: D019380:Anti-HIV Agents
keywords: HIV and AIDS; access to care; government policy; low income; state policy