The annual cost of providing HIV treatment and care in the UK could be as high as £758 million by 2013, investigators suggest in the online journal PLoS One. When the researchers included social care into their calculations, the 2013 cost was estimated to be well over £1000 million.
Ongoing HIV infections will “continue to drive up population cost for HIV services,” argue the authors, who believe that cutting costs in HIV clinics will not have any meaningful impact on HIV expenditure.
The UK has the fastest growing HIV epidemic in Europe, and increasing numbers of patients are using NHS HIV services. The increase in the UK’s HIV population is partly due to the use of antiretroviral therapy resulting in improved survival for many patients. In addition, large numbers of individuals are newly diagnosed with HIV each year.
Sundhiya Mandalia and her team of investigators wished to establish the cost to the NHS of providing treatment and care to HIV-positive patients between 1997 and 2006. They also calculated projected costs in 2013.
Information was gathered from 14 treatment centres, and the patients were divided according to their stage of HIV infection (asymptomatic; symptomatic; AIDS), and the type of antiretroviral therapy they received.
On the basis of NHS service use data gathered by the National Prospective Monitoring System's HIV Health Economics Collaboration, the researchers calculated mean service utilisation levels for each category of patient.
The total number of number of patients using NHS HIV services increased from approximately 17,000 in 1997 to just over 52,000 in 2006. At the same time, the cost of treatment and care increased from £104 million in 1997 to £483 million in 2006. When social and community care costs were included the figures increased to £164 million in 1997 and £683 million in 2006.
For all groups of patients, the proportion of expenditure on treatment increased, and that on care fell.
In 2006, the provision of care and triple-drug antiretroviral therapy cost a little over £18,000 for each asymptomatic patient, and increased the sicker patients became, costing £21,500 for those with symptomatic HIV disease and over £41,000 for patients with AIDS. Care and antiretroviral therapy consisting of four drugs was calculated to cost between £22,775 and £48,000 per patient per year depending on an individual’s health.
By 2013 the researchers project that the total population of HIV-positive people attending NHS services will reach 78,370 and that in 2013 HIV treatment and care services will cost between £720 million and £758 million. But this would increase to as much as £1,065 million when the cost of social and community care was included.
“The direct cost for treatment and care for PLWHIV [people living with HIV] has risen 4.6 fold between 1997 and 2006,” comment the investigators, with costs projected to increase “1.5 fold” between 2007 and 2013.
It is currently recommended that patients should start antiretroviral therapy when their CD4 cell count is around 350 cells/mm3. This will lead to an increase in the number of people taking anti-HIV drugs, and expenditure on therapy will initially rise, note the investigators.
But the researchers believe that this is a price worth paying. “Starting PLWHIV on cost-effective regimens earlier, will maintain them in better health, resulting in fewer health or social services and thereby generating fewer treatment and care costs, while enabling them to remain socially and economically active members of society.”
Nevertheless, the investigators stress the seriousness of the increasing cost of HIV treatment and care, especially at a time when the UK and other world economies are struggling.
“Trying to curtail the cost of service provision is one measure by which one could try and curtail the population cost,” note the authors. But they believe that even if these efforts did not compromise patient care, they would only have a limited impact on expenditure.
Rather, a concerted effort to reduce the ongoing transmission of HIV is much more likely to have a significant impact on costs.
“Only comprehensive prevention strategies, responding directly to the epidemic dynamics operating in each country, will be able to reduce HIV incidence,” they argue.
Mandalia and her colleagues conclude: “Policy makers and other relevant stakeholders need to use evidence-informed HIV prevention, treatment and care strategies…which will prolong life, reduce morbidity and ultimately deliver the best for both the individual and public health agendas.”
Mandilia S et al. Rising population cost of treating people living with HIV in the UK, 1997-2013. PLoS One, 5, 12: e15677, 2010 (click here for access to the free text)