Cost and cost-utility analysis of RiC: A national Retention in Care program in real-world settings
David Holtgrave, Ph.D. & Cathy Maulsby, Ph.D.
Johns Hopkins University
Persons diagnosed with HIV but not retained in HIV medical care accounted for the majority of HIV transmissions in 2009 in the United States (U.S.). There is an urgent need to implement and disseminate HIV retention in care programs; however little is known about the costs associated with implementing retention in care programs. We assessed the costs and cost-utility for six Retention in Care (RiC) programs using standard methods recommended by the U.S. Panel on Cost-effectiveness in Health and Medicine. Program costs from the societal perspective ranged from $47,919 to $423,913 per year or $594 to $2,753 per participant. The programs averted between 0.23-1.65 HIV infections per year. QALYs gained ranged from 1.51-11.00. Using a threshold of $163,889 USD, all of the programs were cost-effective and four were cost-saving. Across a range of program models, retention in care interventions were cost effective (and the majority were cost saving), suggesting that retention in care programs are a judicious use of resources.