July 20, 2015

HIV Treatment as Prevention Saves Money Over Long Term

Written by Marcia Frellick

This article originally appeared on Medscape here.

Expanding treatment as prevention is not only cost-effective over the long term, but when productivity gains are considered, it is cost-saving, a new study indicates.

In British Columbia, the only Canadian province that has adopted complete access, expanding antiretroviral therapy could save up to $65.5 million by 2035, said lead author Bohdan Nosyk, PhD, from the British Columbia Centre for Excellence in HIV/AIDS, who is St. Paul’s Hospital CANFAR Chair in HIV/AIDS Research at Simon Fraser University in Vancouver, British Columbia.

The $65.5 million savings is the result of the difference between a 100% probability of accessing antiretroviral therapy and a 50% probability. At 75% probability, the savings would be $25.1 million by 2035, the study shows.

Dr Nosyk and colleagues studied HIV incidence, prevalence, mortality, costs (in 2010 Canadian dollars), and quality-adjusted life-years in British Columbia from 1997 — after strategies focused on finding people infected with HIV and treating them were implemented — to 2010. These data were compared with scenarios of reduced access.

In their analysis, the team projected potential costs to the province during the next 25 years, using mathematical models.

“We compared what actually happened in BC to scenarios in which we didn’t expand treatment as much as we could have. We found that even fairly small increases in access to treatment were highly cost-effective,” Dr Nosyk told Medscape Medical News. And because getting more people on treatment keeps them alive and employed longer, the increases led to cost savings.

“What makes this study unique is that we built it for British Columbia, using the most extensive data anybody has anywhere,” Dr Nosyk explained. Because the projections are based on what has already happened in British Columbia, they are an accurate representation of how many patients will drop out or not adhere to treatment, he said.

The findings, published online today in the Lancet HIV, will be discussed during a treatment as prevention workshop tomorrow at the 8th International AIDS Society (IAS) Conference.

Productivity gains and reduced hospitalization costs will account for the biggest savings, Dr Nosyk reported. He pointed out that the study results are conservative because capturing data over only a few years does not account for the snowball effect of people not getting infected and then not infecting others.

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