The Cost and Threshold Analysis of Retention in Care (RiC): A Multi-Site National HIV Care Program

• Published in: AIDS and behavior 2017-03, Vol.21 (3), p.643-649
• Main Authors: Maulsby, Catherine, Jain, Kriti M., Weir, Brian W., Enobun, Blessing, Riordan, Maura, Charles, Vignetta E., Holtgrave, David R.
• Format: Article
• Language: English
• Subjects: Accounting; Acquired immune deficiency syndrome; AIDS; Anti-HIV Agents - economics; Anti-HIV Agents - therapeutic use; Attrition; Continuity of Patient Care - economics; Continuity of Patient Care - statistics & numerical data; Cost analysis; Cost assessments; Cost benefit analysis; Cost engineering; Disease transmission; Economic analysis; Health care; Health Care Costs - statistics & numerical data; Health care expenditures; Health Psychology; Health services; HIV; HIV Infections - economics; HIV Infections - prevention & control; HIV Infections - therapy; HIV Infections - transmission; Human immunodeficiency virus; Humans; Infectious Diseases; Lentivirus; Medical diagnosis; Medicine; Medicine & Public Health; Models, Economic; National Health Programs; Original Paper; Outcome and Process Assessment (Health Care); Patient Acceptance of Health Care; Program Evaluation; Program implementation; Public Health; Retention; Retroviridae; Thresholds; United States
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-016-1623-3

Persons diagnosed with HIV but not retained in HIV medical care accounted for the majority of HIV transmissions in 2009 in the United States (US). There is an urgent need to implement and disseminate HIV retention in care programs; however little is known about the costs associated with implementing retention in care programs. We assessed the costs and cost-saving thresholds for seven Retention in Care (RiC) programs implemented in the US using standard methods recommended by the US Panel on Cost-effectiveness in Health and Medicine. Data were gathered from accounting and program implementation records, entered into a standardized RiC economic analysis spreadsheet, and standardized to a 12 month time frame. Total program costs for from the societal perspective ranged from $47,919 to $423,913 per year or $146 to $2,752 per participant. Cost-saving thresholds ranged from 0.13 HIV transmissions averted to 1.18 HIV transmission averted per year. We estimated that these cost-saving thresholds could be achieved through 1 to 16 additional person-years of viral suppression. Across a range of program models, retention in care interventions had highly achievable cost-saving thresholds, suggesting that retention in care programs are a judicious use of resources.