Reaching HIV Care Linkage Goal Would Be Cost-Effective in USA

Improving linkage to care after HIV diagnosis from 65% to 85% in the United States would prolong life and be cost-effective, according to assumptions in a cost-effectiveness analysis by the Centers for Disease Control and Prevention (CDC).

One goal of the US National HIV/AIDS Strategy is to boost the proportion of people linked to care within 3 months of HIV diagnosis from 65% to 85%. Reaching that goal is expected to raise the proportion of people who start antiretroviral therapy and thus to increase life expectancy.
Because longer lifetime antiretroviral therapy will cost more if people start earlier and live longer, CDC researchers planned this cost-benefit analysis. They aimed to determine whether reaching the 85% linkage goal would be cost-effective and to estimate the maximum amount HIV programs could spend on linkage to care and remain cost-effective.
The CDC team used the Progression and Transmission of HIV/AIDS model to estimate how increasing linkage from 65% to 85% would affect life measures and costs. They figured an incremental cost-effectiveness ratio as the additional cost required to hit the 85% target divided by quality-adjusted life-years (QALYs). The researchers assumed that programs costing $100,000 or less per QALY gained are cost-effective.
Reaching the goal of 85% linkage to care would delay the onset of AIDS by 1.2 years and increase life expectancy by 0.4 year on average for every person diagnosed with HIV infection.
Hitting the 85% linkage target would cost an additional $62,200 per QALY gained when the analysis considered only benefits to the diagnosed person. Thus reaching the target would be well within the realm of cost-effectiveness defined by the CDC. The most a program could spend to attain the early-linkage goal and remain cost-effective would be approximately $5100 per diagnosed person.
The CDC researchers conclude that “considerable investment can be cost effectively made to achieve the [US] National HIV/AIDS Strategy goal on early linkage to care.”
Source: Chaitra Gopalappa, Paul G. Farnham, Angela B. Hutchinson, Stephanie L. Sansom. Cost effectiveness of the National HIV/AIDS Strategy goal of increasing linkage to care for HIV-infected persons. JAIDS. 2012; 61: 99-105.

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Written by Mark Mascolini on behalf of the International AIDS Society