HIV POLICY UPDATE

HRSA Unveils Articles Showing Ryan White Program Saves Lives and Dollars

Writing in the Journal of Acquired Immune Deficiency Syndromes, authors from the Health Resources Services Administration (HRSA), including Administrator Dr. Laura Cheever and analysts from Mathematica, Inc. and Mission Analytics Group, Inc., unveiled a new model designed to estimate the cost-effectiveness of the Ryan White HIV/AIDS Program and in a second paper analyzed cost-effectiveness over a 50 year period.  The papers are particularly welcomed by advocates of the program because they demonstrate to key members of the Administration and Congress that the Ryan White Program continues to be a valuable component in working to end the HIV epidemic.

The model simulated injection drug use and sexual contact (for men who have sex with men (MSM) and non-MSM) along the HIV care continuum of testing, HIV diagnosis, linkage to care and treatment to viral suppression.  The validity was tested by comparing the model results for currently estimated HIV incidence, mortality, life expectancy, and lifetime care costs. The authors note that the strong results suggest that “the model captures the dynamics of the current HIV epidemic in the United States and serves as a useful tool for evaluating the cost-effectiveness of a comprehensive system of care for HIV.”

The authors applied the model to the Ryan White Program in the second paper, estimating health care costs and outcomes over a 50-year period.  They found that the Ryan White Program increased the number of people who are virally suppressed by 25.2%, lowered the number of new HIV infections by 18%, lowered the number of deaths by 31% and decreased the cumulative costs by 25%.  Interestingly, this resulted in an estimated cost of $165 billion since more people with HIV are living longer, healthier lives under the program.  The study predicts that over 50 years the Ryan White Program would result in an 18% drop (190,197) in new HIV infections than scenarios without the program.

The authors conclude the Ryan White Program would be considered very cost-effective under standard guidelines.  Given the 50-year limitation, the authors were unable to estimate the impact of the Ryan White Program on life-expectancy (since some of the model agents would still be alive at the end of the period).  Additionally, they note that higher cost medication might reduce cost-effectiveness.  The authors conclude that, “Without the RWHAP, a significant proportion of people with HIV would lose access to care and treatment and the ancillary services that help them become and remain virally suppressed.”

The Academy is pleased to see new evidence of the cost-effectiveness of the Ryan White Program.  We note that the authors have said the model also may be useful in determining cost-effectiveness of policies such as the National Plan to End the HIV Epidemic or to assess the distribution of the relative cost and health outcomes of the Ryan White Program across demographic subgroups and services. We urge policy-makers in the Administration and Congress to review these results and to strongly support the Ryan White Program in the Fiscal Year 2021 Budget and Appropriations process.