and $12,000 per patient per year depending on the regimen and payer (newer formulations of more than one antiretroviral drug may be priced as high as their component parts).15,16,17,29 When additional medical expenses for doctor’s visits, laboratory tests, and drugs to prevent or treat HIV-related opportunistic infections are taken into account, average annual costs rise to approximately $18,000 to $20,000 per patient, with even higher expenses for those with more advanced HIV-related illness.17,18,19,20,21

HIV is increasingly affecting people who are poor, outside the workforce, and have a history of barriers to access.14,22 Even among those individuals who have resources, the costs of HIV care can quickly exhaust their assets and may leave them impoverished. In addition, despite improvements in treatment, HIV/AIDS is often a disabling condition that forces individuals to leave the workforce (or be unable to enter the workforce) thereby losing access to both income and, eventually, private insurance. Indeed, many people with HIV in care are low-income (an estimated 46% have incomes below $10,000 a year) and unemployed (63%).19 Because of these factors, people with HIV rely heavily on the public sector for care.11,23,24

Expenditures for HIV/AIDS care, including public expenditures, have risen significantly over time.23,24 Spending increases largely reflect growing numbers of people living with HIV/AIDS in need of services and increasing health care costs, particularly for prescription drugs. A recent analysis by the National Institute for Health Care Management (NIHCM) Foundation, for example, found that national retail drug expenditures for antiretrovirals totaled $2,572.4 million in 2001, representing an almost 21 percent increase over 2000, compared to a 17% increase for all retail prescription drug sales over the same period.25 Analysis prepared for the Kaiser Family Foundation indicates that Medicaid spending on antiretrovirals increased significantly between 1991 and 1998, particularly after the introduction of HAART.26 Spending on HIV/AIDS treatments by AIDS Drug Assistance Programs (ADAPs) has also increased significantly over time.49

Despite the high costs to patients and the payers and programs that serve them, spending on HIV care (an estimated $6.1 billion in 1998)20 represents only a very small proportion—less than 1%—of estimated spending on overall direct personal health care expenditures in the United States.27 In addition, several studies have demonstrated the cost effectiveness of HIV care when compared to the treatment of many other disabling conditions.17,28,29,30 For example, a recent study found that the cost-effectiveness ratios of combination therapy for HIV infection ranged from $13,000 to $23,000 per quality-adjusted year of life gained (vs. no therapy) compared to $150,000 per quality-adjusted year of life gained for dialysis patients.29

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