We conducted a systematic review (PROSPERO:CRD42020184490) using five databases from 1999-2019. Methods:Studies were included if they reported primary data on lifetime costs for people living with HIV. 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

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Background. Antiretroviral therapy (ART) for HIV has significantly reduced morbidity and mortality, but the drugs can be expensive. This study aimed 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. Results. The average discounted lifetime cost of HIV management was A$282 093 (95% CI : $194 198-421 615). 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 a CD4 count of <200 cells/μL. A 20% or 50% reduction in patented ART costs would reduce the lifetime cost to A$243 638 and A$161 400, respectively. Replacing patented ART drugs with currently available generic equivalents reduced the lifetime cost to A$141 345. Conclusion. The relatively high lifetime costs for managing HIV mean that 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.

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