Lifetime costs of HIV/AIDS medical care

Accurate assessment of medical-care costs associated with HIV disease and AIDS is necessary to forecast the economic consequences of the HIV pandemic and to evaluate the economic efficiency of prevention programs and treatment protocols. A recent issue of this journal contained two important contributions to the literature on lifetime HIV/AIDS-related costs. In the first, Gable et al. provided updated estimates of lifetime treatment costs stratified by stage of disease (CD4+ counts). Projected lifetime costs, from seroconversion until death, were estimated at about $95,000 (1995 dollars). In the second article, Hurley et al. used HIV-related health care costs for homosexual men in Australia to estimate the total treatment costs for each stage of disease. This study also highlighted the importance of discounting future costs and benefits to their present values as well as making explicit assumptions regarding when HIV-infected individuals first access the health care system. The purpose of the present letter is to provide a bridge between the Gable et al. and Hurley et al. articles and to extend the analyses contained therein. As the figure makes clear, the ultimate cost of HIV/AIDS care differs greatly, depending on the stage of disease progression when treatment is initiated. This effect is likely to become even more pronounced with the development and use of more effective, and more costly, early antiretroviral therapies, including protease inhibitor/nucleoside analog combinations. Moreover, as infected people live longer, medical-care costs expended during the final stages of AIDS will decrease as a proportion of overall costs. Attention to matters of discounting and access to care are necessary to ensure accurate assessment of the true costs of HIV/AIDS. Due to uncertainty in this area, analysts should conduct sensitivity analyses using a range of lifetime medical-care cost estimates. Because HIV /AIDS-related costs are fluid, it is important to have up-to-date estimates available to ensure that economic analyses remain as current as possible. Gable, Hurley, and their colleagues are to be commended for their efforts in this area.