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Abstract
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 costs 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 £3169 ($5252) to £3931 ($6515) per person-year for asymptomatic individuals,
£5302 ($8787) to £7929 ($13,140) for patients with symptomatic non-AIDS, and £9956
($16,499) to £21,014 ($34,825) for patients with AIDS. Estimated population-based
indirect costs from the public-sector perspective varied between £109 million ($181
million) and £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 £84
million ($138 million) and £119 (illion ($198 million) in 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.
Keywords
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