PID4: ECONOMIC COST OF HIV INFECTION IN UNTREATED WORKERS: AN EMPLOYER'S PERSPECTIVE

It is necessary to understand the direct and indirect costs of HIV infection in untreated workers in order to estimate the value of aggressive antiretroviral therapies from an employer's perspective. Currently the cost of HIV/AIDS from an employer's perspective is not well understood. OBJECTIVES: To estimate lifetime costs of HIV infection in untreated employees from an employer's perspective. METHODS: A simulation model was developed to predict costs of HIV infection in untreated employees from an employer's perspective over a ten-year time frame. This model utilized age, CD4+ cell counts, and plasma HIV-1 RNA level as major predictors of disease progression and expected patient survival to estimate lifetime costs. Major direct cost components were health insurance premium, life insurance premium, short-term disability benefits, long-term disability benefits, and hiring/training expenses. The indirect cost included productivity loss at work. RESULTS: For a hypothetical 35-year old HIV-positive employee with CD4+ cell counts at 380 cells/mm3 and HIV-1 RNA at 22,000 copies/ml, the model estimated that the total direct and indirect costs of HIV infection was $165,873 from the employer's perspective over a 10-year period. This included $66,659 for health insurance, $12,788 for life insurance costs, $8,580 for short-term and long-term disability benefits, $25,894 for hiring and training expenses and $51,952 due to productivity loss. Sensitivity analyses suggested that changes in employee age, CD4+ cell count, HIV-1 RNA viral load, and CD4+ cell decline rate were important parameters that significantly impact the costs of untreated HIV workers to employers. CONCLUSION: Without effective antiretroviral therapy, HIV infection could result in significant direct and indirect costs to employers. Therefore, the cost-effectiveness of treatment with advanced antiretroviral regimen should be considered for HIV infected workers.