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Lifetime Cost of HIV Management in Australia: An Economic Model

Background: Antiretroviral therapy (ART) for HIV has significantly reduced morbidity and mortality, but the drugs can be expensive. This study aims to estimate the lifetime cost of HIV management from the Australian healthcare perspective. 
 
Methods: A Markov cohort model, consisting of 21 health states based on CD4 count and line of ART, simulated disease progression over the lifetime of persons living with HIV. We reported costs using 2019 Australian dollars (A$) at a discount rate of 3·5% per annum. One-way sensitivity analysis was used to assess the impact of model inputs, and probabilistic sensitivity analyses were conducted to calculate the 95% confidence intervals for the lifetime cost estimate. 
 
Findings: The average discounted lifetime cost of HIV management was A$282,093 [95% CI: $194,206 – 421,345]. The largest proportion of lifetime cost was due to ART (92%). The lifetime cost was most sensitive to third- and second-line ART costs, followed by the probability of failing third-line therapy for those with CD4 count <200. A 20% or 50% reduction in patented ART costs would reduce the lifetime cost to $243,638 and $161,400, respectively. Replacing patented ART drugs with currently available generic equivalents reduced the lifetime cost to A$141,345. 
 
Interpretation: The relatively high lifetime costs for managing HIV means ongoing investment will be required to provide care and treatment to people living with HIV, and supports the urgent need to avert new infections. Reducing the price of ARTs (including consideration of generic drugs) would have the most significant impact on lifetime costs. 
 
Funding: JJO is supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leader Investigator Grant (GNT1193955). The funding body did not influence the research or decision to publish. The Kirby Institute is funded by the Australian Government Department of Health, and is affiliated with the Faculty of Medicine, UNSW Sydney, Australia. 
 
Declaration of Interest: The authors declare that they do not have any competing interest.