Lifetime Productivity Loss Due to HIV Mortality in the United States

OBJECTIVES: Updated estimates of the lifetime productivity loss per HIV infection are needed to inform cost-effectiveness analyses and to help quantify the economic burden of HIV.

METHODS: We used the human capital approach to estimate mortality related lifetime productivity loss per HIV infection in the United States. We incorporated published data on input factors including average annual productivity, life expectancy at HIV diagnosis, number of life years lost due to premature death among persons with HIV (PWH), number of years from HIV infection to diagnosis, and the percentage of deaths in PWH that are attributable to HIV. We used 2018 population-based life expectancy data among all PWH in the US at the median age of HIV diagnosis in the base case, which we compared with scenarios using corresponding data from 2010. To better understand the impact of HIV treatment, we also compared lifetime productivity loss estimates among all PWH in the US to those of a cohort on antiretroviral therapy (ART). We conducted one-way and multi-way sensitivity analyses and discounted costs at a 3% annual rate.

RESULTS: In the base case, we estimated the overall average lifetime productivity loss per HIV infection at $120,000 in 2022 US dollars. The base case results showed a 33% decrease in the estimated lifetime productivity loss compared to the results when applying life expectancy data from 2010. Lifetime productivity loss was 70-80% lower for cohorts of PWH on ART compared to all PWH in the US, after applying life expectancy at varying age of HIV diagnosis. Results were most sensitive to assumptions regarding annual productivity and the number of life years lost per HIV infection.

CONCLUSIONS: Mortality-related productivity losses per HIV infection have decreased substantially in recent years as advances in treatment have led to increases in life expectancy for PWH.