Cost-Effectiveness of HRSA's Ryan White HIV/AIDS Program?

Abstract

Background: With an annual budget of more than $2 billion, the Health Resources and Services Administration's Ryan White HIV/AIDS Program (RWHAP) is the third largest source of public funding for HIV care and treatment in the United States, yet little analysis has been done to quantify the long-term public health and economic impacts of the federal program. Methods: Using an agent-based, stochastic model, we estimated health care costs and outcomes over a 50-year period in the presence of the RWHAP relative to those expected to prevail if the comprehensive and integrated system of medical and support services funded by the RWHAP were not available. We made a conservative assumption that, in the absence of the RWHAP, only uninsured clients would lose access to these medical and support services. Results: The model predicts that the proportion of people with HIV who are virally suppressed would be 25.2 percentage points higher in the presence of the RWHAP (82.6 percent versus 57.4 percent without the RWHAP). The number of new HIV infections would be 18 percent (190,197) lower, the number of deaths among people with HIV would be 31 percent (267,886) lower, the number of quality-adjusted life years would be 2.7 percent (5.6 million) higher, and the cumulative health care costs would be 25 percent ($165 billion) higher in the presence of the RWHAP relative to the counterfactual. Based on these results, the RWHAP has an incremental cost-effectiveness ratio of $29,573 per quality-adjusted life year gained compared with the non-RWHAP scenario. Sensitivity analysis indicates that the probability of transmitting HIV via male-to-male sexual contact and the cost of antiretroviral medications have the largest effect on the cost-effectiveness of the program. Conclusions: The RWHAP would be considered very cost-effective when using standard guidelines of less than the per capita gross domestic product of the United States. The results suggest that the RWHAP plays a critical and cost-effective role in the United States' public health response to the HIV epidemic.

The health equity implications of the Health Resources and Services Administration's Ryan White HIV/AIDS Program

“…Our analysis builds on an ABM developed to estimate the cost-effectiveness of the RWHAP [17,19]. The model is parameterized to represent people with HIV, as well as those at risk of acquiring HIV, in the United States.…”

“…We use evidence from the literature to identify the transition probabilities between the care stages for each subgroup, as well as to determine the health states associated with each care stage. See Goyal et al [17] for additional information on the model and parameters and see the Supplement, http://links.lww. com/QAD/D103 for parameter updates.…”

Assessing the reliability of the CD4 depletion model in the presence of ending the HIV epidemic initiatives

“…Our approach enables us to directly input the incidence and diagnosis delay for each year. Therefore, we do not incorporate an epidemic model to simulate yearly incidence; however, our approach to assessing the CD4 model can be easily extended to these models [11][12][13]. As changes in incidence and diagnosis delay are fully integrated within the first 8 years after an intervention, results beyond this time point are not shown.…”

AIDS Drug Assistance Program disenrollment is associated with loss of viral suppression beyond differences in homelessness, mental health, and substance use disorders: An evaluation in Washington state 2017–2019

“…ADAPs pay for insurance and medical care for 20% of people living with HIV in the United States, and people on the program have high rates of viral suppression, the central measure of successful HIV treatment [ 2 , 3 ]. Despite the benefits of the program, many PLWH struggle to complete the procedures required to maintain enrollment in the program and subsequently become disenrolled [ 4 , 5 ]. However, the effect of ADAP disenrollment, particularly temporary disruptions in coverage, on HIV clinical outcomes is unclear.…”