Modelling the costs of paediatric HIV infection and AIDS

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Abstract
To estimate the cost of managing children with HIV/AIDS in the UK from a health service perspective. Epidemiological, resource use and unit cost data were combined within a decision analytic model. A Markov model was developed to predict the prognoses of HIV-infected children under different assumptions about natural history, treatment efficacy and the timing of antiretroviral therapy. Resource use estimates for various stages of HIV/AIDS were based on published data relating to the UK health service and clinical judgement; unit cost data were taken from a London centre. The base-case results suggest that the cost of caring for an HIV-infected child is higher if the mother's infection was known about at or before the child's birth (antenatal screened cohort): lifetime costs ranged from 46 427 pound sterling to 119 502 pound sterling per child in the screened cohort and from 38 691 pound sterling to 86 014 pound sterling in the unscreened cohort. However, the screened cohort benefited from longer life expectancy (base-case, 11.66 versus 10.09 years) and AIDS-free life expectancy (base-case, 7.13 years versus 6.22 years). Results are sensitive to assumptions about natural history and treatment efficacy: for example, if antiretroviral therapy was initiated at birth, and assuming optimistic natural history parameters, discounted costs could increase to 215 077 pound sterling and the additional lifetime cost of a child born to a screened mother could be 72 491 pound sterling. Results reflect the marked uncertainty regarding the cost of, and prognosis for, children with HIV/AIDS in the new era of more potent antiretroviral combination therapies. These results are part of an assessment of the relative cost-effectiveness of alternative antenatal HIV testing strategies.