This month the U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) published a pair of manuscripts demonstrating the cost-effectiveness of the Ryan White HIV/AIDS Program (RWHAP) in the Journal of Acquired Immune Deficiency Syndromes (JAIDS).
HRSA’s RWHAP provides a comprehensive system of HIV primary medical care, medication, and essential support services for low-income people with HIV. For three decades, the RWHAP has funds granted to states, cities, counties, and local community-based organizations to provide HIV care and treatment services, improve health outcomes, and reduce HIV transmission among hard-to-reach populations. In 2019, 88.1 percent of RWHAP clients receiving HIV medical care were virally suppressed, exceeding the national viral suppression average of 64.7 percent.
These two papers present the findings from the first formal evaluation of the RWHAP’s cost-effectiveness at a national level. The first paper presents a new and innovative mathematical model that can be used as a tool for estimating the cost-effectiveness of the RWHAP under a variety of policy scenarios and assumptions. The second paper compares estimated health care costs and outcomes over a 50-year period in the presence of the RWHAP relative to those expected if the comprehensive and integrated system of medical and support services funded by the RWHAP were not available.
Because the RWHAP is often the only mechanism by which uninsured and underinsured people with HIV can access to HIV care and treatment, the RWHAP is associated with a 25 percentage point increase in people with HIV who reach viral suppression and an 11 percentage point decrease in people with HIV who are lost to care. As a result of improved access to care and treatment under the RWHAP, the model estimates that the presence of the RWHAP is associated with 18 percent fewer new HIV infections and 31 percent fewer deaths among people with HIV.
Over a 50-year period, although cumulative health care costs would be 25 percent higher in the presence of the RWHAP due to increased use of outpatient services and antiretroviral therapy, this model suggests that the health benefits of the RWHAP far outweigh these costs. Using guidelines of the World Health Organization for assessing cost-effectiveness, the RWHAP would be considered very cost-effective, with an incremental cost-effectiveness ratio of $29,573 per quality-adjusted life year (QALY) gained.
The RWHAP plays a critical role in the U.S. public health response to the HIV epidemic, including in the Ending the HIV Epidemic initiative, and represents a cost-effective use of public resources.
For more information on the RWHAP, visit www.hab.hrsa.gov.