Cost and cost threshold analyses for 12 innovative US HIV linkage and retention in care programs

ABSTRACT

Out of >1,000,000 people living with HIV in the USA, an estimated 60% were not adequately engaged in medical care in 2011. In response, AIDS United spearheaded 12 HIV linkage and retention in care programs. These programs were supported by the Social Innovation Fund, a White House initiative. Each program reflected the needs of its local population living with HIV. Economic analyses of such programs, such as cost and cost threshold analyses, provide important information for policy-makers and others allocating resources or planning programs. Implementation costs were examined from societal and payer perspectives. This paper presents the results of cost threshold analyses, which provide an estimated number of HIV transmissions that would have to be averted for each program to be considered cost-saving and cost-effective. The methods were adapted from the US Panel on Cost-effectiveness in Health and Medicine. Per client program costs ranged from $1109.45 to $7602.54 from a societal perspective. The cost-saving thresholds ranged from 0.32 to 1.19 infections averted, and the cost-effectiveness thresholds ranged from 0.11 to 0.43 infections averted by the programs. These results suggest that such programs are a sound and efficient investment towards supporting goals set by US HIV policy-makers. Cost-utility data are pending.

KEYWORDS:

• HIV
• cost analysis
• cost threshold analysis
• economic analysis
• AIDS
• linkage to care
• retention in care
• HIV continuum of care
• continuum of care

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Disclosure statement

No potential conflict of interest was reported by the authors.

ORCiD

Meredith Brantley http://orcid.org/0000-0001-7561-8057

Additional information

Funding

This project is supported by funding agency AIDS United under Grant 90054784. In addition, this report is based upon work supported by the Social Innovation Fund (SIF), Grant 10SIHDC001, a key White House initiative and program of the Corporation for National and Community Service (CNCS). The Social Innovation Fund combines public and private resources to grow the impact of innovative, community-based solutions that have compelling evidence of improving the lives of people in low-income communities throughout the United States. K. Jain was supported by the National Institute of Allergy and Infectious Disease [T32 A1050056-12]. M. Brantley was supported by the National Institute of Allergy and Infectious Disease [T32 AI050056-12] and the National Institute on Drug Abuse [F31 DA038540].