LIFETIME COST OF HUMAN IMMUNODEFICIENCY VIRUS-RELATED HEALTH-CARE

Estimates of the lifetime cost of illnesses are needed for temporal an d international comparisons and for assessment of the efficiency of pr evention strategies. The goal of the present study was to estimate the average present value, at both the time of diagnosis and the time of seroconversion, of the lifetime cost of health care for HIV infection. Australian data on the monthly cost of HIV-related health care for ho mosexual men were linked with published data on disease progression us ing survival analysis methods, Future costs were discounted at 5% per annum. For a patient diagnosed when his CD4(+) count fell below 500 x 10(6)/L, the average present value in 1992-1993 of lifetime cost was s imilar to$93,000, of which 49% was for drugs and 32% was for hospital bed-days. For a man infected in 1992-1993 and diagnosed when his CD4() count falls below 500 x 10(6)/L, the average present value of lifeti me cost at the time of seroconversion is similar to$70,000. These esti mates are lower than the lifetime cost of $119,000 reported recently i n the United States. However, when the U.S. figure was adjusted to mak e discounting of future costs consistent between the two studies, life time costs were similar to 17% lower in the United States. The lower A merican costs appear to be due to lower rates of hospitalization and d rug prescribing, possibly because of reduced access to health services , but underestimation of costs due to study methodology might also exp lain the difference.