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Background and Objectives <p>US youth with HIV (YHIV) face challenges to antiretroviral therapy (ART) adherence and care engagement. Understanding YHIV healthcare costs is essential for healthcare payers and for evaluating the cost-effectiveness of youth-focused interventions.</p> Methods <p>Using the CEPAC-Adolescent microsimulation model, we simulated YHIV cohorts, including those with HIV acquired perinatally (15%) and non-perinatally (85%), aged 13–24 years, in care and prescribed ART. We projected undiscounted life expectancy from model start; per-person and population-level (<i>n</i> = 24,626) lifetime HIV-related healthcare costs (discounted at 3% annually) from a health payer perspective.</p> Results <p>YHIV were projected to live 47.4 life-years after model start, with discounted lifetime HIV-related healthcare costs of $685,000/person ($1,404,000/person undiscounted). Overall, this population would accrue $16.9 billion in discounted HIV-related care costs over their lifetimes. ART medication would comprise most costs (74%), followed by routine HIV-related clinical care (22%), which would be most costly during the time spent at low CD4 counts. ART prices were the most impactful input; generic prices could reduce total lifetime costs by 62% ($264,000/person discounted).</p> Conclusions <p>We projected that US YHIV in care aged 13–24 years would incur nearly $17 billion in lifetime HIV-related healthcare costs. While total costs would increase with improved HIV-related care due to longer life expectancy, monthly costs would be highest during time spent at lower CD4 counts. ART costs would drive lifetime HIV-related healthcare costs for YHIV. Efforts to decrease ART prices and interventions to improve HIV care engagement and support consistent ART use could reduce HIV care costs and improve health outcomes for YHIV.</p>

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Projecting lifetime HIV-related healthcare costs for youth with HIV in the United States

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月5日

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  • Michelle L. Jones,
  • Sujata E. Tewari,
  • Joshua Espada,
  • Kunjal Patel,
  • Clare F. Flanagan,
  • Sarah E. Rutstein,
  • Allison L. Agwu,
  • Kenneth A. Freedberg,
  • Maria E. Trent,
  • John C. Giardina,
  • Emily P. Hyle,
  • Andrea L. Ciaranello,
  • Anne M. Neilan

摘要

Background and Objectives

US youth with HIV (YHIV) face challenges to antiretroviral therapy (ART) adherence and care engagement. Understanding YHIV healthcare costs is essential for healthcare payers and for evaluating the cost-effectiveness of youth-focused interventions.

Methods

Using the CEPAC-Adolescent microsimulation model, we simulated YHIV cohorts, including those with HIV acquired perinatally (15%) and non-perinatally (85%), aged 13–24 years, in care and prescribed ART. We projected undiscounted life expectancy from model start; per-person and population-level (n = 24,626) lifetime HIV-related healthcare costs (discounted at 3% annually) from a health payer perspective.

Results

YHIV were projected to live 47.4 life-years after model start, with discounted lifetime HIV-related healthcare costs of $685,000/person ($1,404,000/person undiscounted). Overall, this population would accrue $16.9 billion in discounted HIV-related care costs over their lifetimes. ART medication would comprise most costs (74%), followed by routine HIV-related clinical care (22%), which would be most costly during the time spent at low CD4 counts. ART prices were the most impactful input; generic prices could reduce total lifetime costs by 62% ($264,000/person discounted).

Conclusions

We projected that US YHIV in care aged 13–24 years would incur nearly $17 billion in lifetime HIV-related healthcare costs. While total costs would increase with improved HIV-related care due to longer life expectancy, monthly costs would be highest during time spent at lower CD4 counts. ART costs would drive lifetime HIV-related healthcare costs for YHIV. Efforts to decrease ART prices and interventions to improve HIV care engagement and support consistent ART use could reduce HIV care costs and improve health outcomes for YHIV.