4.4 Methodology for health care costings for HIV

Initially, a review of national and international literature relating to quality of life assessment and health care for HIV/AIDS was undertaken. Additional information on health care utilisation for HIV/AIDS was sought from various databases and sources, including:

• The Australian HIV Observational Database - data on antiretroviral therapy uptake by risk group and stage of disease, and utilisation of specific HIV investigations (CD4 count and HIV viral load)
• The Highly Specialised Drugs Program - data on use and costs of antiretroviral therapy in Australia

The following assumptions were employed in determination of health care costs for HIV/AIDS:

• All people who acquire HIV infection are at risk of progression to advanced HIV disease.
• The health care costs of acute HIV are small, due to the often asymptomatic nature of newly acquired HIV infection, and therefore were not considered in the total costs.

4.4.1 Costs of antiretroviral therapy
4.4.2 Costs of other HIV/AIDS management

4.4.1 Costs of antiretroviral therapy

Data on antiretroviral therapy use and costs in Australia was obtained from the Highly Specialised Drug Scheme (NCHECR 2001). The per person cost of antiretroviral therapy increased significantly from 1996 (AUD$4,385) to 1997 (AUD$9,163) following the introduction of highly active antiretroviral therapy (HAART) (Table 4.4.1). Based on this data and a previous HIV/AIDS health care costing assessment in Australia (Hurley et al. 1995) we have estimated antiretroviral therapy per person costs to be AUD$4,000 for the period 1990-1996 and AUD$10,500 from 1997 (Table 4.4.2).

Table 4.4.1 Antiretroviral therapy expenditure in Australia, 1996-2000¹

	1996	1997	1998	1999	2000
Total patients	5,617	6,425	6,085	6,296	6,520
Total costs (AUD$)	$24,632,000	$58,876,000	$66,312,000	$67,689,000	$69,413,000
Cost per patient (AUD$)	$4,385	$9,163	$10,897	$10,751	$10,646

¹ Based on data available from the Highly Specialised Drug Scheme and the Australian HIV Observational Database (NCHECR 2001)

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4.4.2 Costs of other HIV/AIDS management

HIV/AIDS Treatment protocols and costs were partly based on the previous HIV/AIDS health care costing assessment in Australia (Hurley et al. 1995). In addition, information on CD4 count and HIV viral load utilisation was obtained from AHOD. Regarding hospitalisation costs (including treatment of complications), the following assumptions were made:

• Only people who have progressed to AIDS are hospitalised.
• Annual hospitalisation, diagnosis and complication treatment costs for people with AIDS prior to 1997 are based on Hurley et al (1995).
• Total hospitalisation, diagnosis and complication treatment costs for people with AIDS are similar in the periods 1990-1996 and from 1997.
• Survival for people with AIDS is approximately 18 months pre-1997 and 3 years from 1997, therefore annual costs for hospitalisation, diagnosis and complication treatment costs for people with AIDS will be reduced by 50% from 1997 (Table 4.4.2).

The above annual costs of treatment of HIV by stage of disease were than converted to Year 2000 prices, where required, by application of the relevant CPI ratio. The annual costs of treatment by stage of disease were then applied to the number of survivors in each stage. Detailed figures of the results are provided in Table 4.4.3 (See Appendix D), with discussion presented in Section 4.6.

Table 4.4.2 Treatment protocols and their costs for HIV disease

Table 4.4.2 is separated into 3 smaller tables in this HTML version for accessibility reasons. It is presented as one table in the PDF version.

1. Early HIV disease¹

Disease stage and health care service costs	Costs
Doctor visits (specialist x 1, primary care x 3)	$213
HIV viral load testing x 3	$528
CD4 count x 3	$60
Other laboratory services (full blood count x 3, biochemistry x 3, liver function tests x 3)	$169
Antiretroviral therapy	$4,000 (1990-1996) $10,500 (from 1997) for estimated 40% on treatment

2. Progressive HIV disease¹

Disease stage and health care service costs	Costs
Doctor visits (specialist x 2, primary care x 4)	$295
HIV viral load testing x 4	$704
CD4 count x 4	$80
Other laboratory services (full blood count x 4, biochemistry x 4, liver function tests x 4)	$225
Antiretroviral therapy	$4,000 (1990-1996) $10,500 (from 1997) for estimated 70% on treatment

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3. AIDS²

Disease stage and health care service costs	Costs
Doctor visits (specialist x 2, primary care x 4)1	$295
HIV viral load testing x 41	$704
CD4 count x 41	$80
Other laboratory services (full blood count x 4, biochemistry x 4, liver function tests x 4)1	$225
Antiretroviral therapy	$4,000 (1990-1996) $10,500 (from 1997) for estimated 90% on treatment
Diagnosis of HIV complications	$3,228 (1990-1996) $1,614 (from 1997)
Prophylaxis and management of opportunistic infections2	$15,132 (1990-1996) $7,566 (from 1997)
Hospital bed-days2	$50,328 (1990-1996) $25,164 (from 1997)

¹ Health care services are per year per case in disease stage, based on CMBS Schedule Fee (2000).
² Cost estimates for AIDS (except antiretroviral therapy from 1997) are based on previous Australian figures from Hurley et al (1995), without adjustment for inflation.

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