The Centers for Disease Control and Prevention (CDC) estimates that between 650,000 and 900,000 people are infected with HIV in the United States and that 500,000 of these people know that they are infected. Most people with HIV disease depend on public sources to pay for needed services, making it important for public agencies to have accurate estimates of HIV treatment costs. According to a recent study, the total costs for treating people with HIV disease in the United States in 1996 were between $6.7 and $7.8 billion, with an average annual cost of treating each person estimated at between $20,000 and $24,700.
Existing cost estimates are derived from a sample of people with HIV disease to extrapolate the cost of treating all people with the disease (patient-based approach). This study by Fred J. Hellinger, Ph.D., and John A. Fleishman, Ph.D., of the Agency for Healthcare Research and Quality, compares estimates using this approach with those of two novel approaches, payer-based estimates (for example, estimates from Medicaid and Medicare) and provider-based estimates (for example, estimates of hospitals, doctors, and pharmaceutical firms). The HIV Cost and Services Utilization Study (HCSUS), the most recent patient-based study, used a national probability sample of 4,042 people with HIV disease from 145 providers in 28 metropolitan areas and 51 providers in 25 rural areas. The researchers using HCSUS data estimated total costs for treating all people with HIV during the first 6 months of 1996 at $6.7 billion and the average per person cost at $20,000.
The total estimate based on data from payers was $7.2 billion, and the provider-based approach yielded a total estimate of $7.8 billion. All of these estimates have their flaws. However, the fact that they are based on different data sources that have different assumptions and still yield similar estimates should give analysts confidence in the range of cost estimates they provide, note the authors. They nevertheless call for better information about the cost of treating people with HIV disease, since most available data are derived from convenience samples that use poorly documented methods to estimate costs.
More details are in "Estimating the national cost of treating people with HIV disease: Patient, payer, and provider data," by Drs. Hellinger and Fleishman, in the June 2000 Journal of Acquired Immunodeficiency Syndromes 24, 182-188.
Reprints (AHRQ Publication No. 00-R058) are available from the AHRQ Publications Clearinghouse.
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