PIN28 - Cost Estimates of Human Immunodeficiency Virus (HIV) Disease Management in the United States - A Literature Review

Abstract

Improvements in anti-HIV therapies have dramatically improved life expectancy for patients but require prolonged exposure to antiretroviral (ARV) regimens. Lifelong management of HIV is becoming increasingly complex as the population ages and issues such as cumulative ARV-associated drug toxicities, increased comorbidity and associated polypharmacy requirements may impact the total cost of care. Estimating the value of HIV management requires contemporary event and health state costs. The objective of this study was to identify contemporary US-specific costs suitable for informing an HIV cost-effectiveness analysis (CEA), given the evolving patient population. A literature review designed according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols checklist was undertaken to identify contemporary English-language economic evaluations of HIV reporting US-specific costs from January 2012 to November 2017. Specific cost elements of interest included: CD4 cell count, AIDS defining events (ADEs), adverse events and other comorbidities. Data were extracted and assessed for applicability; costs were inflated to 2017 values. Twenty-two eligible publications reporting US-specific cost data were identified, with reported total mean annual costs ranging from $9,771 to $52,358. Mean monthly cost was inversely associated with CD4 cell count ranging from ($2,873, for <50 cells/mm3 to $1,192 for >500 cells/mm3). Overall mean per-event costs for ADEs were $10,465 (cervical cancer) to $39,575 (toxoplasmic encephalitis). Other mean event costs included CD4 cell count $70, HIV RNA testing $104, adverse events $6,705), and mean monthly costs of cardiovascular disease $5,898, chronic kidney disease $6,108 and fracture/osteoporosis $4,365. The review identified and summarised wholistic cost estimates appropriate for use within HIV CEA. The degree of heterogeneity in reported costs was noteworthy, with outcomes representing long-term toxicities only available in more contemporary studies. Consequently, it is important that sensitivity analysis is undertaken to explore the impact of individual cost components on cost-effectiveness.