Investing in national AIDS strategies would yield returns, analysis says
Since almost 75 percent of costs are attributable to antiretroviral drug treatment, reducing the price of those drugs could lead to even greater cost
Injecting a little more cash into HIV/AIDS would produce a significant return on investment, according to an analysis led by a team of Massachusetts General Hospital investigators.
By achieving the treatment targets of the National HIV/AIDS Strategy by 2020, not only would hundreds of thousands of new infections and deaths be avoided, but the effort would lead to increasing value over time, the researchers said.
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Meeting NHAS targets would cost $645.7 billion over the next 20 years, compared with $525.3 billion under the current pace -- so putting more money up front would of course be necessary. But the number of lives saved would lead to a cost effectiveness ratio of $68,900 per quality-adjusted life year. That's well within the U.S. cost-effectiveness standard of $100,000 per QALY.
Among the black male populations most susceptible to HIV/AIDS, achieving the NHAS strategy demonstrated even greater value, with a ratio of $38,300 per QALY.
The investigators said that since almost 75 percent of costs are attributable to antiretroviral drug treatment, reducing the price of ART drugs could lead to even greater cost effectiveness.
The NHAS goals are to have 90 percent of HIV-infected individuals know their diagnosis, and for 80 percent of them to successfully suppress the virus through ART drugs. In addition to the monetary savings per patient, meeting those targets is estimated to save more than 2 million years of life over the next 20 years.
Released by the White House in 2015, the NHAS was designed to bring U.S. HIV/AIDS policies in line with those of the Joint United Nations Programme on HIV/AIDS, which calls for diagnosing 90 percent of HIV-infected people worldwide, linking 90 percent of identified cases to ART, and achieving suppression of the virus among 90 percent of ART recipients. Hitting the NHAS targets would achieve successful virologic suppression in 72 percent of infected patients, compared with current estimates of 49 percent.
Using a mathematical model for assessing the cost effectiveness of preventing HIV/AIDS, the investigators compared the forecasted results of continuing the current pace of HIV diagnosis, linkage to and retention in treatment, and viral suppression to those of achieving the NHAS goals -- projecting both clinical benefits and costs over a 20-year period. While continuing at the current pace would result in 750,000 deaths from HIV/AIDS over 20 years, achieving NHAS would reduce total deaths to 551,000, preventing almost 200,000 deaths.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
