The European Journal of Health Economics

, Volume 19, Issue 3, pp 327–340 | Cite as

Economic and public health consequences of delayed access to medical care for migrants living with HIV in France

  • Marlène Guillon
  • Michel Celse
  • Pierre-Yves Geoffard
Original Paper


In 2013, migrants accounted for 46% of newly diagnosed cases of HIV (human immunodeficiency virus) infection in France. These populations meet with specific obstacles leading to late diagnosis and access to medical care. Delayed access to care (ATC) for HIV-infected migrants reduces their life expectancy and quality of life. Given the reduction of infectivity under antiretroviral (ARV) treatment, delayed ATC for HIV-infected migrants may also hinder the control of the HIV epidemic. The objective of this study is to measure the public health and economic consequences of delayed ATC for migrants living with HIV in France. Using a healthcare payer perspective, our model compares the lifetime averted infections and costs of early vs. late ATC for migrants living with HIV in France. Early and late ATC are defined by an entry into care with a CD4 cell count of 350 and 100/mm3, respectively. Our results show that an early ATC is dominant, even in the worst-case scenario. In the most favorable scenario, early ATC generates an average net saving of €198,000 per patient, and prevents 0.542 secondary infection. In the worst-case scenario, early ATC generates an average net saving of €32,000 per patient, and prevents 0.299 secondary infection. These results are robust to various adverse changes in key parameters and to a definition of late ATC as an access to care at a CD4 level of 200/mm3. In addition to individual health benefits, improving ATC for migrants living with HIV proves efficient in terms of public health and economics. These results stress the benefit of ensuring early ATC for all individuals living with HIV in France.


HIV/AIDS Migrant populations France Access to care Public policy 

JEL Classification

I180 I13 



We are very grateful to Virginie Supervie, Stéphane Le Vu, and France Lert for the comments and suggestions. We also thank the members of CESP, especially Kayigan d’Almeida and France Lert, for allowing us to access the VESPA 2 data.

Compliance with ethical standards

Declaration of interests

MG reports a grant of the Ile-de-France Region for the funding of her PhD. MG also reports a grant from the French National AIDS Council for this study. This work was supported by the Agence Nationale de la Recherche of the French government through the program “Investissements d’avenir ’’ ANR-10-LABX-14-01’’. MC and PYG declare no competing interests. MC is an expert advisor to the French National AIDS Council. PYG is a professor at Paris School of Economics and a member of the French National AIDS Council.

Role of the funding source

The funding source had no involvement in study design, analysis and interpretation of data; in the writing of the article and the decision to submit it for publication.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Université Clermont Auvergne, CNRS, CERDI and Paris School of EconomicsClermont-FerrandFrance
  2. 2.Conseil National du Sida-French National AIDS CouncilParis Cedex 15France
  3. 3.Paris School of EconomicsParisFrance

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