Using a Happiness Index to Measure the Benefits for a Cost Benefit Analysis of Antiretrovirals for Older Adults with HIV in New York City

Background: Anti-retroviral (ARV) medications have greatly increased the life expectancies of those who are HIV positive. As life expectancy increases, so does the age of those on the medications. This has come at the cost of billions of dollars. It is important to carry a Cost-Benefit Analysis (CBA) to evaluate ARVs for older adults living with HIV who are often depressed to see whether the medications have been worthwhile in the past and are likely to be so in the future. Methods: A new methodology based on a happiness index was created to value benefits of older adults with and without depression in New York City. The benefits are given as the product of the number of QALYs (Quality Adjusted Life Years) times the price of a QALY. The QALY price is determined by estimating the trade-off between health satisfaction and income in a regression equation with overall life satisfaction as the dependent variable. Cost and the number of life years gained from the medications are taken from the literature. Results: Net-benefits and benefit-cost ratios were presented separately for those depressed and non-depressed and by era of medication. For the depressed group, the ARVs generated large positive net-benefits in all eras with Benefit-Cost ratios in the range 1.4 to 1.9. For the non-depressed groups, the net-benefits were positive only in the two periods prior to 2000. Conclusion: In the past ARVs have been found to be socially worthwhile. But pharmaceutical companies face challenges in order for ARVs to continue being worthwhile. There are diminishing returns associated with the benefits of ARVs and costs have increased greatly. Benefits are obtained in the future and have to be discounted. Costs are immediate and have to be incurred throughout a person’s lifetime. Cost containment should be a priority.