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Cost and Cost-Effectiveness of Incentives for Viral Suppression in People Living with HIV

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A Correction to this article was published on 10 February 2024

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Abstract

Only 63% of people living with HIV in the United States are achieving viral suppression. Structural and social barriers limit adherence to antiretroviral therapy which furthers the HIV epidemic while increasing health care costs. This study calculated the cost and cost-effectiveness of a contingency management intervention with cash incentives. People with HIV and detectable viral loads were randomized to usual care or an incentive group. Individuals could earn up to $3650 per year if they achieved and maintained an undetectable viral load. The average 1-year intervention cost, including incentives, was $4105 per patient. The average health care costs were $27,189 per patient in usual care and $35,853 per patient in the incentive group. We estimated a cost of $28,888 per quality-adjusted life-year (QALY) gained, which is well below accepted cost-per-QALY thresholds. Contingency management with cash incentives is a cost-effective intervention for significantly increasing viral suppression.

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Funding

The study was supported by the National Institute of Allergy and Infectious Diseases and the National Institute on Drug Abuse of the National Institutes of Health under grants R01AI117065 and T32DA07209.

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Authors and Affiliations

  1. Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA

    Laura J. Dunlap, Stephen Orme & Gary A. Zarkin

  2. School of Public Health, and Center for Collaborative HIV Research in Practice and Policy, State University of New York, Albany, NY, USA

    David R. Holtgrave

  3. Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Catherine Maulsby

  4. Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Andrew M. Rodewald, August F. Holtyn & Kenneth Silverman

  5. RTI International, 701 13th Street NW, Suite 750, Washington, DC, 20005-3967, USA

    Stephen Orme

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  1. Laura J. Dunlap
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Correspondence to Stephen Orme.

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The authors declare that they have no conflict of interest.

Ethical Approval

The Johns Hopkins Medicine Institutional Review Board approved the study. The study was monitored by a Scientific Advisory Committee. Staff members reported all events that might be considered adverse events, including deaths, and the investigators determined if any events met the definitions of adverse events as defined by the Johns Hopkins Medicine Institutional Review Board. The investigators, the Scientific Advisory Committee and the Johns. Hopkins Medicine Institutional Review Board reviewed all adverse events annually. The study team registered the trial on Clinicialtrials.gov before recruitment began (NCT02363387).

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Dunlap, L.J., Orme, S., Zarkin, G.A. et al. Cost and Cost-Effectiveness of Incentives for Viral Suppression in People Living with HIV. AIDS Behav 26, 795–804 (2022). https://doi.org/10.1007/s10461-021-03439-x

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