Cost and Cost-Effectiveness of Incentives for Viral Suppression in People Living with HIV

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...

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Bibliographic Details
Published in:AIDS and behavior 2022-03, Vol.26 (3), p.795-804
Main Authors: Dunlap, Laura J., Orme, Stephen, Zarkin, Gary A., Holtgrave, David R., Maulsby, Catherine, Rodewald, Andrew M., Holtyn, August F., Silverman, Kenneth
Format: Article
Language:English
Subjects:
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Contingency
Cost analysis
Cost-Benefit Analysis
Costs
Drug use
Health behavior
Health care
Health care expenditures
Health Psychology
Health services
HIV
HIV Infections - drug therapy
Human immunodeficiency virus
Humans
Incentives
Infectious Diseases
Intervention
Medicine
Medicine & Public Health
Motivation
Original Paper
Patient compliance
Patients
Public Health
Quality-Adjusted Life Years
United States
Viral Load
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Summary: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.
ISSN:1090-7165
1573-3254
DOI:10.1007/s10461-021-03439-x