Research Article| Volume 22, ISSUE 11, P1333-1345, November 2000

Download started.


Indirect cost of HIV infection in England

      This paper is only available as a PDF. To read, Please Download here.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Johnson AM
        • Adler MW
        • Crown JM
        The acquired immune deficiency syndrome and epidemic of infection with human immunodeficiency virus: Costs of care and prevention in an inner London district.
        Br Med J. 1986; 293: 489-492
        • Johnson AM
        • Shergold C
        • Hawkins A
        • et al.
        Patterns of hospital care for patients with HIV infection and AIDS.
        J Epidemiol Community Health. 1993; 47: 232-237
        • Beck EJ
        • Kennelly J
        • McKevitt C
        • et al.
        Changing use of hospital services and costs at a London AIDS referral centre, 1983–1989.
        AIDS. 1994; 8: 367-377
        • Nageswaran A
        • Kinghorn G
        • Shen R
        • et al.
        Hospital service utilization by HIV/AIDS patients and their management cost in a provincial genitourinary medicine department.
        Int J STD AIDS. 1995; 6: 336-344
        • Kennelly JM
        • Tolley KH
        • Ghani AC
        • et al.
        Hospital costs of treating haemophilic patients infected with HIV.
        AIDS. 1995; 9: 787-793
        • Postma MJ
        • Tolley K
        • Leidl RM
        • et al.
        Hospital care for persons with AIDS in the European Union: Assessment of current and future impact controlled for severity-stages.
        Health Policy. 1997; 41: 157-176
        • Beck EJ
        • Tolley K
        • Power A
        • et al.
        • NPMS Steering Group
        Use and cost of HIV service provision in England in 1996.
        Pharmacoeconomics. 1998; 14: 639-652
        • Beck EJ
        • Tolley K
        Financing HIV service provision in England: Estimated impact of the cost of antiretroviral combination therapy.
        Int J STD AIDS. 1998; 9: 512-517
        • Beck EJ
        • Pozniak A
        • Molesworth A
        • et al.
        • NPMS Steering Group
        Changing cost of English HIV service provision 1996–1997.
        Int J STD AIDS. 1999; 10: 357-362
        • Hurley SF
        • Kaldor JM
        • Gardiner S
        • et al.
        Lifetime cost of human immunodeficiency virus—related health care.
        J Acquired Immune Defic Syndr Hum Retrovirol. 1996; 12: 371-378
        • Holtgrave DR
        • Pinkerton SD
        Updates of cost of illness and quality of life estimates for use in economic evaluations of HIV prevention programs.
        J Acquired Immune Defic Syndr Hum Retrovirol. 1997; 16: 54-62
        • Gebo KA
        • Chaisson RE
        • Folkemer JG
        • et al.
        Costs of HIV medical care in the era of highly active antiretroviral therapy.
        AIDS. 1999; 13: 963-969
        • Hellinger FJ
        Forecasts of the costs of medical care for persons with HIV: 1992–1995.
        Inquiry. 1992; 29: 356-365
        • NHS Executive
        Hospital and Community Health Services Revenue (Pay and Prices) Inflation Index. NHS Executive Finance and Performance Department A, Leeds, UK1999
        • Alexander J
        • Fenby A
        • Suto T
        • Beasley N
        Positive Lives Employment Survey 1997. Chronos Publishing Ltd, London, UK1997
        • PHLS AIDS Centre
        AIDS Surveillance and HIV Death Clinical Report Form. PHLS Communicable Disease Surveillance Centre, London, UK1993
        • Petrou S
        • Dooley M
        • Whitaker L
        • et al.
        Cost and utilisation of community services for people with HIV infection in London.
        Health Trends. 1995; 27: 62-68
      1. Benefits Agency Communications and Customer Liaison Branch, Department of Social Security, Leaflet MG1. Available at: Accessed June 19, 1998.

        • Luce BR
        • Manning WG
        • Siegel JE
        • Lipscomb J
        Estimating cost in cost-effectiveness analysis.
        in: Gold MR Siegel JE Russell LB Weinstein MC Cost-Effectiveness in Health and Medicine. Oxford University Press, New York1996: 183-184
        • Rice DP
        Estimating the Cost of Illness. US Dept of Health, Education, and Welfare, Public Health Service, Division of Medical Care Administration, Health Economics Branch, Washington, DC1966 (US Public Health Service Publication 947-6)
        • Lubeck DP
        • Fries JF
        Changes in quality of life among persons with HIV infection.
        Qual Life Res. 1992; 1: 359-366
      2. Family Expenditure Survey 1997–1998. Office of National Statistics, London, UK1999 (Available at:
        • Koopsmnschap MA
        • Rutten FF
        The impact of indirect costs on outcomes of health care programs.
        Health Econ. 1994; 3: 385-393
        • Koopmanschap MA
        • Rutten FF
        • van Roveld BM
        • van Roijen L
        The friction cost method for measuring indirect costs of disease.
        J Health Econ. 1995; 14: 171-189
        • Beck EJ
        • Mandalia S
        • Williams I
        • et al.
        • NPMS Steering Group
        Decreased morbidity and use of hospital services in English HIV-infected individuals with increased uptake of anti-retroviral therapy 1996–1997.
        AIDS. 1999; 13: 2157-2164
        • Bowie RD
        • Tobias MI
        • Williams T
        The private costs of HIV/AIDS.
        New Zealand Med J. 1996; 109: 51-54
        • Aplasca MR
        • Monzon OT
        • Mapua CA
        • et al.
        An analysis of the direct and indirect costs of HIV infection/AIDS in the Philippines.
        International Conference on AIDS. July 7–12, 1996; (Presented at) (Vancouver, British Columbia, Canada. Abstract TuD250)
        • Obremskey S
        • Viravaidya M
        • Sittitrai W
        • Brown T
        Current estimates of the economic costs of AIDS in Thailand and their regional impacts.
        International Conference on AIDS. August 7–12, 1994; (Presented at) (Yokohama, Japan. Abstract PD0382)
        • Samkaram S
        • Samkaram H
        Economic impact due to AIDS.
        Ninth International Conference on AIDS. June 6–11, 1993; (Presented at) (Berlin, Germany. Abstract PO-D28-4206)
        • Vlaev R
        Economic analysis of health-care cost of HIV antibody positive individuals in Bulgaria.
        International Conference on AIDS. June 20–23, 1990; (Presented at) (San Francisco, California. Abstract FD126)
        • Rice DP
        • Hodgson TA
        • Kopstein AN
        The economic costs of illness: A replication and update.
        Health Care Financ Rev. 1985; 7: 61-80
        • Hardy AM
        • Rauch K
        • Echenberg D
        • et al.
        The economic impact of the first 10,000 cases of acquired immunodeficiency syndrome in the United States.
        JAMA. 1986; 255: 209-211
        • Hanvelt RA
        • Ruedy NS
        • Hogg RS
        • et al.
        Indirect costs of HIV/AIDS mortality in Canada.
        AIDS. 1994; 8: F7-F11
        • Beck EJ
        • Mandalia S
        • Power A
        • et al.
        • NPMS-HHC Steering Group
        Reduced HIV disease progression and mortality due to cART in English NPMS-HHC clinics.
        International Conference on AIDS. July 9–14, 2000; (Poster presented at) (Durban, South Africa. Abstract 3331)