Indirect cost of HIV infection in England

Background: Few studies have estimated the indirect costs of care for HIV infection in England by stage of infection at a population level. Objective: This study estimated annual indirect costs of the HIV epidemic in England in 1997-1998 from both a public-sector and societal perspective. Methods: Service costs for HIV-infected individuals were indexed to 1997-1998 English prices. Average annual indirect costs included the costs of statutory, community, and informal services; disability payments; and lost economic productivity by stage of HIV infection. Disability payments were excluded from the societal perspective, whereas the degree of lost economic productivity was varied for the sensitivity analyses. Total average annual indirect casts by stage of HIV infection were calculated, as were population-based costs by stage of HIV infection and overall population costs. Results: Annual indirect costs from the public-sector and societal perspectives, respectively, ranged from pound 3169 ($5252) to pound 3931 ($6515) per person-year for asymptomatic individuals, pound 5302 ($8787) to pound 7929 ($13,140) for patients with symptomatic mon-AIDS, and pound 9956 ($16,499) to pound 21,014 ($34,825) for patients with AIDS. Estimated population-based indirect costs from the public-sector perspective varied between pound 109 million ($181 million) and pound 145 million ($241 million) for 1997-1998, respectively, comprising between 58% and 124% of direct treatment costs for triple drug therapy in England during 1997. From the societal perspective, estimated population-based costs varied between pound 84 million ($138 million) and pound 119 million ($198 million) ire 1997-1998, comprising between 45% and 102% of direct treatment costs and cost of care, respectively, during 1997. Conclusions: Average indirect costs increase as HIV-infected individuals' illness progresses. Whether one takes a public-sector or societal perspective, indirect costs add a considerable amount to the cost of delivering health care to HIV-infected individuals. Both direct and indirect costs, when obtainable, should be used to assess the economic consequences of HIV infection and treatment interventions.