If the United States were to ratchet up the diagnosis and successful treatment of people living with HIV to hit the National HIV/AIDS Strategy (NHAS) targets by 2020, the extra expense would likely prove cost-effective and prevent hundreds of thousands of deaths.
The Obama administration released the NHAS in 2015, establishing a goal of getting 90 percent of the U.S. HIV population diagnosed and 72 percent on ARVs and virally suppressed by 2020.
According to a recent Centers for Disease Control and Prevention (CDC) analysis, of an estimated 1.1 million people living with HIV in the United States in 2014, 85 percent were diagnosed and 49 percent had a fully suppressed viral load.
Researchers from a new cost-effectiveness study conducted mathematical modeling to project key metrics of the epidemic over two decades either if current trends persist or if such trends escalate to achieve the NHAS 2020 goals. Maintaining the current pace means that a projected 750,000 people will die of HIV- and AIDS-related causes during the next two decades, compared with a projected 551,000 people if the NHAS targets are met.
The 20-year epidemic-related costs associated with current trends would be an estimated $523 billion, compared with $646 billion tied to meeting NHAS targets. Consequently, the cost of adding one quality-adjusted life-year (a composite measure of expanded life and improved health) would be $68,900; a figure below $100,000 in this context typically indicates a cost-effective expenditure.
Because three quarters of the costs examined in this analysis stem from the price of antiretrovirals, price reductions for HIV medications would only improve cost-effectiveness.
“We have all the tools we need—treatment and prevention—to extend the survival of those with HIV to near normal and to finally end this epidemic,” says Rochelle Walensky, MD, MPH, chief of Massachusetts General Hospital’s Division of Infectious Diseases and the senior author of the report. “Our study demonstrates that these goals are no longer simply aspirational, they are achievable and within our economic reach. What we need now is the dedication, the resources and the political will, all of which will be repaid by not forwarding this deadly epidemic to our children.”