Abstract
This review of published studies on the costs of HIV treatment and care describes some of the recent developments that have influenced these costs in industrialised and industrialising countries, especially within the context of changing drug treatments. Some of the different approaches to estimating the economic impact of HIV infection are briefly presented. The methods used to review the literature are described, particularly the criteria of a scoring system that was specifically developed to systematically screen some of the studies identified. The mean review score for studies dealing with direct hospital costs increased significantly (p = 0.003) over the 3 periods analysed (before 1987, 1987 to 1995, and 1996 and beyond), indicating that the overall ‘quality’ of studies increased over time.
All cost estimates, other than those from non-industrialised regions, were converted to 1996 US dollars using country-specific total health expenditure inflaters and country-specific Gross Domestic Product Purchasing Power Parity converters. A summary of hospital cost estimates over time and by region demonstrated that the costs of treating asymptomatic individuals and people with symptomatic non-AIDS increased over the period, but that the costs of treating individuals with AIDS appears to have stabilised since the late 1980s. As fewer studies could be identified on the costs of community and informal care, indirect productivity costs and population cost estimates, and costs of care for children with HIV infection, all of these studies were reviewed without the use of the scoring system.
Finally, the discussion explores the evidence on the global costs of HIV in non-industrialised economies and the affordability of HIV treatment and care. Some suggestions for the direction of future HIV costing studies are also presented. A need remains for good quality cost data. Adequate research effort should be directed to improving the scope and quality of information on costs of HIV service provision around the world.
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References
Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 1997
Scitovsky AA. Studying the cost of HIV-related illnesses: reflections on the moving target. Milbank Q 1989; 67: 318–44
Shapiro MF, Morton SC, McCaffrey DF, et al. Variations in the care of HIV-infected adults in the United States: results from the HIV cost and services utilization study. JAMA 1999; 281: 2305–15
Centers for Disease Control. Pneumocystis pneumonia. MMWR Morb Mortal Wkly Rep 1981; 30: 250
Centers for Disease Control. Kaposi’s sarcoma. MMWR Morb Mortal Wkly Rep 1981; 30: 305–8
UNAIDS. AIDS epidemic update. Joint United Nations Programme on AIDS. Geneva: World Health Organization, 1999
Merson M. HIV infection: the global perspective. J Acquir Immune Defic Syndr 1991; 4: 305
Mann JM, Chin J. AIDS: a global perspective. N Engl J Med 1988; 319: 302–3
Pepin J, Plummer FA, Brunham RC, et al. The interaction of HIV infection and other sexually transmitted diseases: an opportunity for intervention. AIDS 1989; 3: 3–9
Centers for Disease Control. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morb Mortal Wkly Rep 1992; 41: 1–19
Ho DD, Neumann AU, Perelson AS, et al. Rapid turnover of plasma virions and CD4 lymphocytes on HIV-1 infection. Nature 1995; 373: 123–6
Wei X, Ghosh SK, Taylor ME, et al. Viral dynamics in human immunodeficiency virus type 1 infection. Nature 1995; 373: 117–22
Fischl MA, Richman DD, Grieco MH, et al. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind, placebo-controlled trial. N Engl J Med 1987; 317: 185–91
Hammer SM. Advances in antiretroviral therapy and viral load monitoring. AIDS 1996; 10 Suppl. 3: S1–11
Delta Co-ordinating Committee. Delta: a randomised double blind controlled trial comparing combinations of zidovudine plus didanosine or zalcitabine with zidovudine alone in HIV infected individuals. Lancet 1996; 348: 283–91
Saravolatz LD, Winslow DL, Collins G, et al. Zidovudine alone or in combination with didanosine or zalcitabine in HIV-infected patients with the acquired immunodeficiency syndrome or fewer than 200 CD4 cells per cubic millimeter. Investigators for the Terry Beirn Community Programs for Clinical Research on AIDS. N Engl J Med 1996; 335: 1099–106
Perelson AS, Essunger P, Cao Y, et al. Decay characteristics of HIV-1-infected compartments during combination therapy. Nature 1997; 387: 188–91
Gazzard B, Moyle G. 1998 revision to the British HIV Association guidelines for antiretroviral treatment of HIV seropositive individuals. BHIVA Guidelines Writing Committee. Lancet 1998; 352: 314–6
Beck EJ, Mandalia S, Parmer D, et al., NPMS Steering Group. Reduced HIV disease progression and mortality due to combination antiretroviral therapy in English NPMS-HHC clinics [poster TuPeC3331]. 13th International AIDS Conference; 2000 Jul 11; Durban
Carpenter CC, Fischl MA, Hammer SM, et al. Antiretroviral therapy for HIV infection in 1997. Updated recommendations of the International AIDS Society — USA Panel. JAMA 1997; 277: 1962–9
Carpenter CC, Fischl MA, Hammer SM, et al. Antiretroviral therapy for HIV infection in 1998: updated recommendations of the International AIDS Society — USA Panel. JAMA 1998; 280: 78–86
Curtis H. Funding implications of combination therapies. J Comb Ther 1997; 2: 27–8
Bloom DE, River Path Association. Something to be done: treating HIV/AIDS. Science 2000; 288: 2171–3
Finkler SA. The distinction between costs and charges. Ann Intern Med 1982; 96: 102–9
Beck EJ, Beecham J, Mandalia S, et al. What is the cost of getting the price wrong? J Public Health Med 1999; 21: 311–7
Rees M. Report on the HIV/AIDS costing ‘revisit’. London: Department of Economics, University of Buckingham, 1995
Wright KG, Haycox A. Public sector costs of caring for mentally handicapped persons in a large hospital. Discussion paper no. 1. York: Centre for Health Economics, University of York, 1984
Tolley K, Gyldmark M. The treatment and care costs of people with HIV infection or AIDS: development of a standardised cost framework for Europe. Health Policy 1993; 24: 55–70
Knapp M. Background theory. In: Netten A, Beecham J, editors. Costing community care: theory & practice. Aldershot: Ashgate Publishing Ltd, 1993
Knapp M, Beecham J, Renshaw J. The cost-effectiveness of psychiatric provision services. Personal Social Services Research Unit discussion paper 533/2. Kent: University of Kent, 1987
The World Bank. World Bank development report 1998/99: knowledge for development. New York (NY): Oxford University Press, 1999
Hiatt RA, Quesenberry CPJ, Selby JV, et al. The cost of acquired immunodeficiency syndrome in northern California. The experience of a large prepaid health plan. Arch Intern Med 1990; 150: 833–8
Solomon DJ, Hogan AJ, Bouknight RR, et al. Analysis of Michigan Medicaid costs to treat HIV infection. Public Health Rep 1989; 104: 416–24
Andrews RM, Keyes MA, Fanning TR, et al. Lifetime medical service utilization and expenditures for AIDS in New York and California. J Acquirr Immune Defic Syndr 1991; 4: 1046–58
Moss NE, Kahn JG, Benjamin AE, et al. Medical care utilization and associated charges for patients with symptomatic HIV disease. AIDS Public Policy J 1991; 6: 125–9
Beck EJ, Kennelly J, McKevitt C, et al. Changing use of hospital services and costs at a London AIDS referral centre, 1983–1989. AIDS 1994; 8: 367–77
Whyte BM, Evans DB, Schreurs EJ, et al. The costs of hospital-based medical care for patients with the acquired immunodeficiency syndrome. Med J Austr 1987; 147: 269–72
Scitovsky AA, Cline MW, Abrams DI. Effects of the use of AZT on the medical care costs of persons with AIDS in the first 12 months. J Acquir Immune Defic Syndr 1990; 3: 904–12
Seage III GR, Landers S, Lamb GA, et al. Effect of changing patterns of care and duration of survival on the cost of treating the acquired immunodeficiency syndrome (AIDS). Am J Public Health 1990; 80: 835–9
Bennett CL, Cvitanic M, Pascal A. The costs of AIDS in Los Angeles. J Acquir Immune Defic Syndr 1991; 4: 197–203
Andrulis DP, Weslowski VB, Hintz E, et al. Comparisons of hospital care for patients with AIDS and other HIV-related conditions. JAMA 1992; 267: 2482–6
Bennett C, Pascal A, Cvitanic M, et al. Medical care costs of intravenous drug users with AIDS in Brooklyn. J Acquir Immune Defic Syndr 1992; 5: 1–6
Rietmeijer CA, Davidson AJ, Foster CT, et al. Cost of care for patients with human immunodeficiency virus infection. Patterns of utilization and charges in a public health care system. Arch Intern Med 1993; 153: 219–25
Hellinger FJ, Fleishman JA, Hsia DC. AIDS treatment costs during the last months of life: evidence from the ACSUS. Health Serv Res 1994; 29: 569–81
Epstein AM, Seage G, Weissman JS, et al. Costs of medical care and out-of-pocket expenditures for persons with AIDS in the Boston Health Study. Inquiry 1995; 32: 211–21
Moore RD, Chaisson RE. Costs to Medicaid of advancing immunosuppression in an urban HIV-infected patient population in Maryland. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 14: 223–31
Perdue EB, Weidle PJ, Everson-Mays RE, et al. Evaluating the cost of medications for ambulatory HIV-infected persons in association with landmark changes in antiretroviral therapy. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 17: 354–60
Abou-Sayf FK, Marzolf JR. Medical care costs of patients with AIDS in Hawaii. Hawaii Med J 1989; 48: 194–9
Beck EJ, Whitaker L, Kennelly J, et al. Changing presentation and survival, service utilization and costs for AIDS patients: insights from a London referral centre. AIDS 1994; 8: 379–84
Kennelly JM, Tolley KH, Ghani AC, et al. Hospital costs of treating haemophilic patients infected with HIV. AIDS 1995; 9: 787–93
Nageswaran A, Kinghorn GR, Shen RN, et al. Hospital service utilization by HIV/AIDS patients and their management cost in a provincial genitourinary medicine department. Int J STD AIDS 1995; 6: 336–44
Beck EJ, Kupek EJ, Petrou S, et al. Survival and the use and costs of hospital services for London AIDS patients treated with AZT. Int J STD AIDS 1996; 7: 507–12
Chancellor JV, Hill AM, Sabin CA, et al. Modelling the cost effectiveness of lamivudine/zidovudine combination therapy in HIV infection. Pharmacoeconomics 1997; 12 (1): 54–66
Brettle RP, Atkinson FI, Wilcock J, et al. The cost of health care for HIV-positive patients. Int J STD AIDS 1997; 8: 50–3
Beck EJ, Kupek EJ, Wadsworth J, et al. The use and cost of hospital services by London AIDS patients with different AIDS defining conditions. J Public Health Med 1996; 18: 457–64
Borleffs JC, Jager JC, Poos MJ, et al. Hospital cost for patients with HIV infection in a University Hospital in the Netherlands. Health Policy 1990; 16 (1): 43–54
Hurley SF, Kaldor JM, Carlin JB, et al. The usage and costs of health services for HIV infection in Australia. AIDS 1995; 9: 777–85
Peyron F, Flori A, Galliano-di Bernardo Bernardo S, et al. Evaluation of drug use and cost of hospital care for AIDS patients between 1990 and 1994. Pharm World Sci 1997; 19 (4): 202–7
McDermott J, Williamson E, Wallace E, et al. Hospital outpatient costs for patients with HIV infection. N Z Med J 1991; 104: 43–4
Dijkgraaf MG, Luijben AH, Jager JC, et al. In-patient care for symptomatic, HIV-infected persons: a longitudinal study of hospitalizations, in-patient drug use, and related costs. AIDS Care 1995; 7: 321–36
De Graeve D, Lescrauwaet B, Nonneman W. Patient classification and cost analysis of AIDS and HIV: the case of Belgium. Health Policy 1997; 39: 93–106
Beck EJ, Tolley K. Financing HIV service provision in England: estimated impact of the cost of antiretroviral combination therapy. Int J STD AIDS 1998; 9: 512–7
Beck EJ, Tolley K, Power A, et al. The use and cost of HIV service provision in England in 1996. Pharmacoeconomics 1998; 14 (6): 639–52
Beck EJ, Pozniak A, Molesworth A, et al. Changing cost of English HIV service provision, 1996–1997. Int J STD AIDS 1999; 10: 357–62
Okello DO. Resource utilization patterns in patients with acquired immunodeficiency syndrome (AIDS). East Afr Med J 1994; 71: 816–7
Berger R. Cost analysis of AIDS cases in Maryland. Md Med J 1985; 34: 1173–5
Scitovsky AA, Cline M, Lee PR. Medical care costs of patients with AIDS in San Francisco. JAMA 1986; 256: 3103–6
Kaplowitz LG, Turshen IJ, Myers PS, et al. Medical care costs of patients with acquired immunodeficiency syndrome in Richmond, Va. A quantitative analysis. Arch Intern Med 1988; 148: 1793–7
Kelly JV, Ball JK, Turner BJ. Duration and costs of AIDS hospitalizations in New York. Variations by patient severity of illness and hospital type. Med Care 1989; 27: 1085–98
Seage GR, Landers S, Barry A, et al. Medical care costs of AIDS in Massachusetts. JAMA 1986; 256: 3107–9
Johnson AM, Adler MW, Crown JM. The acquired immune deficiency syndrome and epidemic of infection with human immunodeficiency virus: costs of care and prevention in an inner London district. Br Med J (Clin Res Ed) 1986; 293: 489–92
Bjornson DC, Oster CN, Hiner Jr WO, et al. The relationship between outpatient drug costs and disease progression in the human immunodeficiency virus-infected population. DICP 1991; 25 (4): 414–7
Chupka LA, Birden HH, Andrews L. Financial aspects of the provision of care to AIDS patients at Hartford Hospital. Conn Med 1992; 56: 467–8
Weiss PJ, Kennedy CA, Wallace MR, et al. Medication costs associated with the care of HIV-infected patients. Clin Ther 1993; 15: 912–6
Allison-Cooke S. The pattern and cost of hospital care for persons with HIV/AIDS in Guilford County, NC, 1987–1991. N C Med J 1994; 55 (4): 131–4
Rosenblum LS, Castro KG, Dooley S, et al. Effect of HIV infection and tuberculosis on hospitalizations and cost of care for young adults in the United States, 1985 to 1990. Ann Intern Med 1994; 121: 786–92
Andrulis DP, McGregor CM, Weiss KB, et al. U.S. hospital care for HIV-infected persons and the role of public and private teaching hospitals. J Acquir Immune Defic Syndr Hum Retrovirol 1995; 9: 193–203
Fleishman JA, Mor V, Laliberte LL. Longitudinal patterns of medical service use and costs among people with AIDS. Health Serv Res 1995; 30: 403–24
Rüttimann S, Tschudi M, Dubach UC. Medical care cost of ambulatory patients infected with the human immunodeficiency virus: analysis at a Swiss outpatient clinic. Eur J Intern Med 1992; 3: 141–6
Swaden L, Sabin CA, Phillips AN. CD4 lymphocyte count as a predictor of drug expenditure in a cohort of anti-HIV seropositive haemophiliacs. Int J Pharm Pract 1992; 1: 210–1
Carlsson R, Dickson N, McDermott J, et al. Hospital associated costs of treating patients with AIDS. N Z Med J 1993; 106: 76–8
Morton A, McCallum AK, Parkin DW, et al. The patient profile approach to assessing the cost of AIDS and HIV infection. J Publ Health Med 1993; 15: 235–42
Peter DL, McDougall M, Maartens G, et al. The cost of adult AIDS inpatient care. S Afr Med J 1994; 84: 447–8
Jebakumar SP, Woolley PD, Curless E. Lifetime cost of treating a person with HIV infection. Int J STD AIDS 1995; 6: 444–6
Anis AH, Hogg RS, Yip B, et al. Average annual drug cost and its determinants in a population based cohort of HIV-positive adult men and women. Pharmacoeconomics 1998; 13 (3): 327–36
Gebo KA, Chaisson RE, Folkemer JG, et al. Costs of HIV medical care in the era of highly active antiretroviral therapy. AIDS 1999; 13: 963–9
Organization for Economic Co-operation and Development (OECD)/CREDES. OECD health data 99: a comparative analysis of 29 countries [CD-ROM]. Paris: OECD/CREDES, 1999
Ward D, Brown MA. Labor and cost in AIDS family caregiving. West J Nurs Res 1994; 16: 10–22
Bowie RD, Tobias MI, Williams T. The private costs of HIV/ AIDS. N Z Med J 1996; 109: 51–4
Petrou S, Dooley M, Whitaker L, et al. Cost and utilisation of community services for people with HIV infection in London. Health Trends 1995; 27: 62–8
Petrou S, Dooley M, Whitaker L, et al. The economic costs of caring for people with HIV infection and AIDS in England and Wales. Pharmacoeconomics 1996; 9(4): 332–40
Hansen K, Woelk G, Jackson H, et al. The cost of home-based care for HIV/AIDS patients in Zimbabwe. AIDS Care 1998; 10: 751–9
Hardy AM, Rauch K, Echenberg D. The economic impact of the first 10,000 cases of acquired immunodeficiency syndrome in the United States. JAMA 1986; 255: 209–11
Scitovsky AA, Rice DP. Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991. J Med Pract Manage 1988; 3: 234–41
Begley CE, Crane MM, Perdue G. Estimating themortality cost of AIDS: do estimates of earnings differ? Am J Public Health 1990; 80: 1268–70
Seidman RL, Williams SJ, Mortensen LM. Assessing the economic impact of AIDS in local communities. Current and projected costs for San Diego County. West J Med 1989; 151: 467–71
Bozzette SA, Berry SH, Duan N, et al. The care of HIV-infected adults in the United States. HIV Cost and Services Utilization Study Consortium. N Engl J Med 1998; 339: 1897–904
Herlitz C, Brorsson B. The AIDS epidemic in Sweden: estimates of costs, 1986, 1987 and 1990. Scand J Soc Med 1989; 17: 39–48
Postma MJ, Leidl R, Downs AM, et al. Economic impact of the AIDS epidemic in the European Community: towards multinational scenarios on hospital care and costs. AIDS 1993; 7: 541–53
Pandav CS, Anand K, Shamanna BR, et al. Economic consequences of HIV/AIDS in India. Natl Med J India 1997; 10: 27–30
Konde-Lule JK, Sebina AJ. The impact of AIDS in a rural Ugandan community. East Afr Med J 1993; 70: 725–9
Farnham PG, Gorsky RD. Costs to business for an HIV-infected worker. Inquiry 1994; 31: 76–88
Leigh JP, Lubeck DP, Farnham P, et al. Potential and actual workdays lost among patients with HIV. J Acquir Immune Defic Syndr Hum Retrovirol 1995; 8: 392–8
Beck EJ, Mandalia S, Williams I, et al. Decreased morbidity and use in hospital services in English HIV infected individuals with increased uptake of anti-retroviral therapy 1996–1997. AIDS 2000; 13: 2157–64
Koopmanschap MA, Rutten FFH, van Ineveld BM, et al. The friction cost method for measuring indirect costs of disease. J Health Econ 1995; 14: 171–89
Hegarty JD, Abrams EJ, Hutchinson VE, et al. The medical care cost of human immunodeficiency virus-infected children in Harlem. JAMA 1988; 260: 1901–5
Conviser R, Grant CM, Coye MJ. Pediatric acquired immunodeficiency syndrome hospitilizations in New Jersey. Pediatrics 1991; 87: 642–53
Muller C, Fahs MC, Mulak G, et al. Pediatric AIDS at Mount Sinai Medical Center 1988-89: a study of costs and social severity. Soc Work Health Care 1996; 22: 1–20
Hsia DC, Fleishman JA, East JA, et al. Pediatric human immunodeficiency virus infection: recent evidence on the utilization and costs of health services. Arch Pediatr Adolesc Med 1995; 149: 489–96
Havens PL, Cuene BE, Holtgrave DR. Lifetime cost of care for children with human immunodeficiency virus infection. Pediatr Infect Dis J 1997; 16: 607–10
Carlin JB, Langdon P, Hurley SF, et al. Health care and its costs for children with perinatally acquired HIV infection. J Paediatr Child Health 1996; 32: 42–7
Beck EJ, Mandalia S, Griffith R, et al. Use and cost of hospital and community service provision for children with HIV infection at an English HIV referral centre. Pharmacoeconomics 2000; 17 (1): 53–69
Nelson E, Weikert M, Phillips JA. Paediatric treatment costs and the HIV epidemic. Cent Afr J Med 1995; 41: 139–44
Youle M, Trueman P, Simpson K, et al. Health economics in HIV disease: a review of the European literature. Pharmacoeconomics 1999; 15 Suppl. 1: 1–12
Hogg RS, O’shaughnessy MV, Gataric N, et al. Decline in deaths from AIDS due to new antiretrovirals [letter]. Lancet 1997; 349: 1294
Mouton Y, Alfandari S, Valette M, et al. Impact of protease inhibitors on AIDS-defining events and hospitalizations in 10 French AIDS reference centres. Federation National des Centres de Lutte contre le SIDA. AIDS 1997; 11: F101–5
Wurst J. Health Africa: UN Security Council, breaking tradition, takes up AIDS. Inter Press Service [online]. Available from: URL: http://www.aegis.com/news/ips/2000/IP000105.html2000 [Accessed 2000 Aug 30]
Beck EJ, Miners AH. Assessing HIV service provision: why costs are also important. In: Miles A, editor. The effective management of HIV disease. London: Aesculapius Medical Press. In press
Direction des Hospitaux, M.S. DMI2: an information system built around the patient. INSERIM — SC4. Paris: Ministere de la Sante et de l’action Humanitaire, 1993
Beck EJ. Counting the cost of HIV service provision in England: where do we go from here? J HIV Comb Ther 1997; 2: 29–32
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Keith Tolley was located at Nottingham University when this work was first undertaken, but is currently Senior Health Economist at Glaxo Wellcome UK.
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Beck, E.J., Miners, A.H. & Tolley, K. The Cost of HIV Treatment and Care. Pharmacoeconomics 19, 13–39 (2001). https://doi.org/10.2165/00019053-200119010-00002
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DOI: https://doi.org/10.2165/00019053-200119010-00002