Lifetime Cost of HIV Care in France during the Era of Highly Active Antiretroviral Therapy

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Abstract
Objective: To estimate the treatment and health care costs of HIV infection or AIDS in France during the era of highly active antiretroviral therapy (HAART). Design: We used a clinical database of HIV-infected patients to calculate the resource use and cost of care for different stages of HIV infection. Costs were incorporated into a computer-based, probabilistic simulation model of the natural history and treatment of HIV infection to estimate the lifetime cost of treating patients with HIV disease. Setting: A northern France HIV clinical cohort. Participants: 1232 HIV-infected patients followed from January 1994 through July 1998. Results: In the absence of an AIDS-defining event, the average total cost of care ranged from 670 euros (1 euro=US $1.19) per person-month in the highest CD4 stratum (>500/μl) to 1060 euros per person-month in the lowest CD4 stratum (≤50/μl). The mean cost of care was estimated at 3370 euros per person-month during the initial months around the occurrence of an AIDS-defining event; at 1750 euros per person-month during the period spanning from 2 months after the diagnosis of specific AIDS-defining event to 1 month prior to death; and at 13 010 euros per person-month in the final month prior to death. If clinical management of HIV infection began at a CD4 cell count of 378/μl, as in this cohort, the discounted lifetime cost of treating an HIV-infected French patient was estimated at 214 000 euros. The undiscounted costs were 309 000 euros over a projected life expectancy of 16.4 years. Conclusion: The cost of HIV disease varies widely depending upon the stage of illness. These estimates of stage-specific and lifetime costs of HIV care will assist health policy planners in assessing the burden of disease in the era of HAART and projecting future resource requirements.