Socio-economic impact of antiviral intervention.

In this paper we present a meta-analysis of the Cost-of-Illness of HIV/AIDS and the socio-economic impact of antiretroviral therapy. We distinguish between provider costs, direct household costs, and indirect costs. There is a growing number of publications on provider costs in different countries, but the methodology and the degree of precision between these papers make it difficult to give a good estimate of the current provider costs of treating HIV/AIDS cases. There seems to be a declining interest in health economic analysis of HIV/AIDS, and usually data is rather obsolete at the date of publication. In addition, we know hardly anything about household costs not covered by health insurances (e.g., transport to the provider, special diet). There are more studies on indirect costs, but even these studies are difficult to compare due to methodological differences. Even under these conditions we can state that in highly developed countries HAART is cost-effective. Because of an increase of life expectancy, the life-time provider costs increase under this drug regime. But, on the contrary, the indirect costs strongly decrease. In particular for employed and young HIV/AIDS cases in the USA and in Europe, HAART is an investment that pays back. In countries and in compartments of the population (e.g., unemployed, pensioners) where the loss of labor can be neglected, the positive effects of HAART on the indirect costs do not necessarily justify its costs. The cost-effectiveness analysis of antiviral therapy has to be seen under the precondition that no long-term effects, such as drug resistance, occur. Future analysis might show that we strongly underestimated the long-term costs of HIV/AIDS.