The Cost-Effectiveness of Financial Incentives for Viral Suppression: HPTN 065 Study

Abstract

Objective: To evaluate the cost-effectiveness of financial incentives for human immunodeficiency virus (HIV) viral suppression compared to standard of care. Study Design: Mathematical model of 2-year intervention offering financial incentives ($70 quarterly) for viral suppression (<400 copies/ml 3 ) based on the HPTN 065 clinical trial with HIV patients in the Bronx, NY and Washington, D.C. Methods: A disease progression model with HIV transmission risk equations was developed following guidelines from the Second Panel on Cost-Effectiveness in Health and Medicine. We used health care sector and societal perspectives, 3% discount rate, and lifetime horizon. Data sources included trial data (baseline N ¼ 16,208 patients), CDC HIV Surveillance data, and published literature. Outcomes were costs (2017 USD), quality-adjusted life years (QALYs), HIV infections prevented, and incremental cost-effectiveness ratio (ICER). Results: Financial incentives for viral suppression were estimated to be costsaving from a societal perspective and cost-effective ($49,877/QALY) from a health care sector perspective. Compared to the standard of care, financial incentives gain 0.06 QALYs and lower discounted lifetime costs by $4210 per patient. The model estimates that incentivized patients transmit 9% fewer infections than the standard-of-care patients. In the sensitivity analysis, ICER 95% credible intervals ranged from cost-saving to $501,610/QALY with 72% of simulations being cost-effective using a $150,000/QALY threshold. Modeling results are limited by uncertainty in efficacy from the clinical trial. Conclusions: Financial incentives, as used in HTPN 065, are estimated to improve quality and length of life, reduce HIV transmissions, and save money from a societal perspective. Financial incentives offer a promising option for enhancing the benefits of medication in the United States.

The efficacy and cost‐effectiveness of a family‐based economic empowerment intervention (Suubi + Adherence) on suppression of HIV viral loads among adolescents living with HIV: results from a Cluster Randomized Controlled Trial in southern Uganda

“…Overall, our results are in line with studies from low‐resource settings showing that EE interventions have the potential to improve adherence outcomes among ALWHIV by mitigating the effects of poverty [16,29]. Our findings are also consistent with studies from high‐income countries reporting that financial incentives to promote ART adherence in low‐income populations are not only effective, but can also be cost‐effective in suppressing VL in HIV patients [35].…”

Global estimates for the lifetime cost of managing HIV

“…the difference between studies may be due to methodological fabrication. Adamson et al, 2019 [88] Micro costing using [80] Micro costing using published data…”

Home‐Based Intervention to Test and Start (HITS): a community‐randomized controlled trial to increase HIV testing uptake among men in rural South Africa

“…Financial incentives have been used to promote various healthy behaviours such as medication adherence [13], reduction of substance misuse [14], or use of preventive services including voluntary medical male circumcision [15][16][17]. Recently, several clinical trials showed promising results that financial incentives could increase the uptake of HIV testing as well as linkage to care and viral load suppression but the efficacy has been varying [18][19][20][21][22][23][24][25][26]. While financial incentives may serve as once-off extrinsic motivation, providing information specific to individuals' needs can improve intrinsic motivation and empower individuals to make an informed decision to take HCT [27,28].…”