Do reduced inpatient costs associated with highly active antiretroviral therapy (HAART) balance the overall cost for HIV treatment?

In this article we analyse how the costs of treating patients with HIV infection in the US have changed over time, with an emphasis on the relationship between inpatient hospitalization costs and the costs of highly active antiretroviral therapy (HAART). We examine how HIV treatment modes have evolved by comparing the pre-HAART treatment period before 1996-7 with the subsequent use of HAART. We describe the sources of data on HIV healthcare service utilization, the costs of those services, and the differences between the annual costs of treating all patients with different stages of HIV and the lifetime costs of treating a person with HIV from the time of infection. The major question in estimating HIV treatment costs and their components is how to incorporate a complete set of services utilized from all providers of HIV treatment for a representative sample of patients with HIV. The literature reviewed varies significantly on both of these factors. Although the hospitalization of patients with HIV has been declining over the past 2 decades, this rate of decrease accelerated after the introduction of HAART. Initially, the declines in hospitalization and its associated costs were greater than the increases in drug therapy costs, so the annual total costs of treating patients with HIV decreased. However, subsequent studies failed to show decreases in overall annual treatment costs, given rising drug costs and increases in hospitalizations due to complications from, or resistance to, HAART and due to other diseases impacting HIV-infected patients. Although the lifetime costs of treating a person with HIV have also increased, this treatment has resulted in substantial gains in the length and quality of life for those living with HIV.