Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA.
RTI International, 701 13th Street NW, Suite 750, Washington, DC, 20005-3967, USA.
AIDS Behav. 2022 Mar;26(3):795-804. doi: 10.1007/s10461-021-03439-x. Epub 2021 Aug 26.
Only 63% of people living with HIV in the United States are achieving viral suppression. Structural and social barriers limit adherence to antiretroviral therapy which furthers the HIV epidemic while increasing health care costs. This study calculated the cost and cost-effectiveness of a contingency management intervention with cash incentives. People with HIV and detectable viral loads were randomized to usual care or an incentive group. Individuals could earn up to $3650 per year if they achieved and maintained an undetectable viral load. The average 1-year intervention cost, including incentives, was $4105 per patient. The average health care costs were $27,189 per patient in usual care and $35,853 per patient in the incentive group. We estimated a cost of $28,888 per quality-adjusted life-year (QALY) gained, which is well below accepted cost-per-QALY thresholds. Contingency management with cash incentives is a cost-effective intervention for significantly increasing viral suppression.
在美国，仅有 63%的艾滋病毒感染者实现了病毒抑制。结构和社会障碍限制了抗逆转录病毒治疗的依从性，这进一步加剧了艾滋病毒的流行，同时增加了医疗保健成本。本研究计算了采用现金奖励的应急管理干预措施的成本和成本效益。具有可检测病毒载量的艾滋病毒感染者被随机分配到常规护理或激励组。如果患者实现并维持不可检测的病毒载量，他们每年最多可以赚取 3650 美元。平均每年干预成本包括奖励措施，每位患者为 4105 美元。在常规护理中，每位患者的平均医疗保健费用为 27189 美元，而在激励组中，每位患者的医疗保健费用为 35853 美元。我们估计每获得一个质量调整生命年（QALY）的成本为 28888 美元，远低于可接受的每 QALY 成本阈值。采用现金奖励的应急管理是一种成本效益高的干预措施，可以显著提高病毒抑制率。
