Cost-Effectiveness Analysis Combining Medical and Mental Health Services for Older Adults with HIV in New York City.

Older adults with the human immunodeficiency virus or HIV (OAWH), people 50 years and older, are aging with the disease and experience low quality of life. Mental health disorders trigger and worsen health inequalities with larger impacts on the quality of life of OAWH. This paper evaluated two rival health interventions using a standard decision-analytic model and quantified the cost per quality-adjusted life-years (QALY) to understand the differential in cost and effectiveness of an additional unit of perfect health. HIV medical care was compared with a combined strategy that includes both HIV medical and behavioral care. Primary data from a convenience sample (n=139) collected in New York City and outcomes for healthy older adults from the literature were used in this study. The incremental cost-effectiveness ratio (ICER) evaluating the economic cost and health benefits of the new intervention was $36,166 per QALY, which is less than the willingness to pay ($75,000). The ICER for Hispanics was $35,325 and for White/Caucasians was $40,499. Integrated medical plus behavioral care is cost-effective and improves quality of life among OAWH. Given the high rates of mental health disorders along with an underutilization of behavioral care among OAWH, timely and effective mental health programs are paramount to increase quality of life.