January 5, 2012
In this section, we list some of the most recent and significant publications that include key input parameters researchers might use in model-based cost-effectiveness analyses. It is not intended to provide a comprehensive overview of these topic areas -- only to give readers an idea of some key works in the field.
A large fraction of the economic burden of HIV/AIDS is the medical costs of treating persons with HIV. Medical cost estimates are often based on health care utilization by persons with HIV disease. The costs associated with health care utilization in each disease stage are summed across all disease stages from infection to death. The average annual cost of HIV care in the ART era was estimated to be $19,912 (in 2006 dollars; $23,000 in 2010 dollars).3 The most recent published estimate of lifetime HIV treatment costs was $367,134 (in 2009 dollars; $379,668 in 2010 dollars).4
Testing in health care settings
Several U.S.-based studies have evaluated the cost-effectiveness of routine opt-out HIV screening in clinical settings. These settings included emergency departments, primary care settings, urgent care centers, and STD clinics. The results were generally consistent. The cost per new diagnosis ranged from $1,900 to $10,000 (in 2010 dollars), and varied by setting and testing implementation strategy.5-9
Testing in non-health care settings
Non-health care settings, such as jails/prisons, community-based organizations (CBOs), and outreach venues, are also common places to implement HIV testing programs. Individuals eligible for testing in those settings could be identified through partner services or social networks. Cost-effectiveness studies of these strategies have found the results generally consistent within similar settings. For example, the cost per new HIV diagnosis associated with CBO-sponsored activities ranged from $10,334 to $20,413 (2010 dollars).10-11 Variance in the cost per new HIV diagnosis was more pronounced when evaluating HIV testing programs in jails (from $2,946 per new diagnosis in Florida jails to $30,392 in Wisconsin jails),12 reflecting the differences in undiagnosed HIV prevalence among inmates as well as differences in implementation costs.
The use of highly active antiretroviral therapy (HAART) since 1996 has significantly improved survival for persons infected with HIV. Schackman et al. estimated life expectancy from the time of infection to be 32.1 years from a large dataset of persons in routine outpatient care in the current treatment era.4 Using U.S. national HIV surveillance data, another study estimated that average life expectancy after an HIV diagnosis increased from 10.5 to 22.5 years from 1996 to 2005.13
HIV survival data have been reported slightly differently in the literature because of various definitions of timeframe, e.g., time from HIV seroconversion to AIDS, time from seroconversion to death, and time from HIV diagnoses to death. Survival also varies by gender, age at infection, mode of infection, and the timing of initiation of antiretroviral therapy.14-17
Recent HIV incident estimates
CDC published new incidence estimates in 2011 using a refined methodology that allowed for an updated 2006 incidence estimate (previously 56,300) as well as new estimates for 2007, 2008, and 2009. These new estimates showed that the annual number of new HIV infections was stable overall from 2006 through 2009:18
More HIV surveillance reports can be found at: www.cdc.gov/hiv/topics/surveillance/resources/reports/index.htm
HIV transmission risk varies by different modes of transmission. The most common transmission modes include unprotected receptive and insertive anal intercourse, unprotected receptive and insertive vaginal intercourse, and contaminated needle sharing. The estimates of these and other per-act or per-partner transmission probabilities can be found in the listed references of systematic reviews and meta-analyses.19-22
Many studies have reported quality-of-life estimates for HIV infection and AIDS. Published estimates vary by study design and assessment method.23,24 Tengs et al conducted a meta-analysis of utility estimates for HIV/AIDS to elicit utilities from patients on a scale ranging from 0.0 for death to 1.0 for perfect health. The study is commonly cited for reporting a pooled estimate of utility of 0.70 for AIDS patients, 0.82 for symptomatic HIV patients, and 0.94 for asymptomatic HIV patients .25
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