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Global Estimates for the Lifetime Cost of Managing HIV: A Systematic Review
45 Pages Posted: 30 Oct 2020
More...Abstract
Background: There are over 38 million people living with HIV (PLHIV), with significant economic consequences. We aimed to collate global lifetime costs for managing PLHIV.
Methods: We conducted a systematic review (PROSPERO:CRD42020184490) using five databases from 1999-2019. Studies were included if they reported primary data on lifetime costs for PLHIV. Two reviewers independently assessed the titles and abstracts, and data were extracted from full texts: lifetime cost, year of currency, country of currency, discount rate, time horizon, perspective, method used to estimate cost, and cost items included. Descriptive statistics were used to summarize the discounted lifetime costs (2019 USD).
Results: Of 505 studies found, 260 full-texts were examined and 75 included. Fifty (67%) studies were from high-income, 22 (29%) from middle-income and 3 (4%) from low-income countries. Of 65 studies which reported study perspective, 45 (69%) were healthcare provider and the remainder were societal. The median lifetime costs for managing HIV differed according to: 1) country income level: $5,221 (IQR:2,978–11,177) for low-income to $372,018 (IQR:227,220–540,222) for high-income; 2) study perspective: $189,230 (IQR:14,794–424,069) for healthcare provider, to $408,955 (IQR:148,503–684,355) for societal; and 3) decision model: $190,255 (IQR:13,588–429,772) for Markov cohort, to $283,905 (IQR:10,558–453,779) for microsimulation models.
Interpretation: Estimating the lifetime costs of managing HIV is useful for budgetary planning and to ensure HIV management is affordable for all. Furthermore, HIV prevention strategies need to be strengthened to avert these high costs of managing HIV.
Funding Statement: JJO, CFK, EPF are supported by the Australian National Health and Medical Research Council Fellowship grants (GNT1104781, GNT1172900 and GNT1172873 respectively).
Declaration of Interests: None to declare.
Keywords: HIV, health economics, cost
Suggested Citation: Suggested Citation