Rising Population Cost for Treating People Living with HIV in the UK, 1997-2013

Background: The number of people living with HIV (PLHIV) is increasing in the UK. This study estimated the annual population cost of providing HIV services in the UK, 1997-2006 and projected them 2007-2013. Methods: Annual cost of HIV treatment for PLHIV by stage of HIV infection and type of ART was calculated (UK pounds, 2006 prices). Population costs were derived by multiplying the number of PLHIV by their annual cost for 1997-2006 and projected 2007-2013. Results: Average annual treatment costs across all stages of HIV infection ranged from 17,034 pound in 1997 to 18,087 pound in 2006 for PLHIV on mono-therapy and from 27,649 pound in 1997 to 32,322 pound in 2006 for those on quadruple-or-more ART. The number of PLHIV using NHS services rose from 16,075 to 52,083 in 2006 and was projected to increase to 78,370 by 2013. Annual population cost rose from 104 pound million in 1997 to 483 pound million in 2006, with a projected annual cost between 721 pound and 758 pound million by 2013. When including community care costs, costs increased from 164 pound million in 1997, to 683 pound million in 2006 and between 1,019 pound and 1,065 pound million in 2013. Conclusions: Increased number of PLHIV using NHS services resulted in rising UK population costs. Population costs are expected to continue to increase, partly due to PLHIV's longer survival on ART and the relative lack of success of HIV preventing programs. Where possible, the cost of HIV treatment and care needs to be reduced without reducing the quality of services, and prevention programs need to become more effective. While high income countries are struggling to meet these increasing costs, middle- and lower-income countries with larger epidemics are likely to find it even more difficult to meet these increasing demands, given that they have fewer resources.