Development of a Mathematical Model to Estimate the Cost-Effectiveness of HRSA's Ryan White HIV/AIDS Program

Abstract

Background: The Health Resources and Services Administration's Ryan White HIV/AIDS Program provides services to more than half of all people diagnosed with HIV in the United States. We present and validate a mathematical model that can be used to estimate the long-term public health and cost impact of the federal program. Methods: We developed a stochastic, agent-based model that reflects the current HIV epidemic in the United States. The model simulates everyone's progression along the HIV care continuum, using 2 network-based mechanisms for HIV transmission: injection drug use and sexual contact. To test the validity of the model, we calculated HIV incidence, mortality, life expectancy, and lifetime care costs and compared the results with external benchmarks. Results: The estimated HIV incidence rate for men who have sex with men (502 per 100,000 person years), mortality rate of all people diagnosed with HIV (1663 per 100,000 person years), average life expectancy for individuals with low CD4 counts not on antiretroviral therapy (1.52–3.78 years), and lifetime costs ($362,385) all met our validity criterion of within 15% of external benchmarks. Conclusions: The model represents a complex HIV care delivery system rather than a single intervention, which required developing solutions to several challenges, such as calculating need for and receipt of multiple services and estimating their impact on care retention and viral suppression. Our strategies to address these methodological challenges produced a valid model for assessing the cost-effectiveness of the Ryan White HIV/AIDS Program.

Estimating contact network properties by integrating multiple data sources associated with infectious diseases

“…27 including processes with two infectious periods. 5,28,29 Another common epidemic process is an SEIR process. The Stages S and R still refer to Susceptible and Recovered, respectively.…”

“…Specifically, we set the parameters for the exponential distributions that govern the lengths of the infectious acute and long‐term periods such that the durations have a mean of 3 months ($$$ {\kappa}_A=3 $$$) and 42 months ($$$ {\kappa}_L=42 $$$), respectively 29 . Based on existing literature, $$$ {\beta}_A=0.01505 $$$ and $$$ {\beta}_L=0.008911817 $$$ 29 Simple viral evolution process: Genetic data for the pathogen consists of sequences of 1048 base pairs.…”

“…Afterwards, individuals move to Stage $$$ R $$$, which represents that the individual has recovered, been admitted to the hospital, been placed on treatment, or died. Epidemic models commonly use multiple infectiousness periods to investigate HIV, 27 including processes with two infectious periods 5,28,29 …”

Assessing the reliability of the CD4 depletion model in the presence of ending the HIV epidemic initiatives

“…Our approach enables us to directly input the incidence and diagnosis delay for each year. Therefore, we do not incorporate an epidemic model to simulate yearly incidence; however, our approach to assessing the CD4 model can be easily extended to these models [11][12][13]. As changes in incidence and diagnosis delay are fully integrated within the first 8 years after an intervention, results beyond this time point are not shown.…”

Sensor Mathematical Model Data Fusion Biobjective Optimization

“…And vision sensor because there are fewer pixels and low noise, high sensitivity has been occupying the mainstream market. Due to the improvement of process level and integrated circuit design technology, researchers have found that some of the shortcomings of the visual sensor can find ways to overcome and has no inherent characteristics of the visual sensor, such as high integration, small size, low power consumption, and lightweight, making the visual sensor become a hot spot for research in recent years [20].…”