Economic impact of delaying or preventing AIDS in persons with HIV

Objectives: To investigate how preventing or delaying the development of acquired immune deficiency syndrome (AIDS) [or other severe conditions related to the human immunodeficiency virus (HIV)] through antiretroviral therapy affects the lifetime cost of HIV/AIDS care, and to compare the cost of therapy with the potential savings in HIV/AIDS-related end-of-life care. Methods: The analysis utilized a previously developed economic model of HIV/AIDS-related medical care costs under various disease progression scenarios to compare the costs and benefits of antiretroviral therapy. Results: The analysis suggests that: (1) recent projections of long-term medical care cost savings due to highly effective protease inhibitor combination therapies are probably illusory; (2) it makes relatively little difference to the overall long-term cost of HIV/AIDS care whether combination antiretroviral therapy completely prevents or just substantially delays progression to AIDS; and (3) although combination therapy is not likely to save economic resources in the long run, it nevertheless can be highly cost effective. Conclusions: The health-related benefits of antiretroviral therapy are not free, but appear to be worth the cost.