OBJECTIVES: The aim of this study is to estimate the clinical and economic impact of ART in Spain over a 32-year period (1987-2018).

METHODS: A cost-benefit analysis was performed, using a second-order Monte Carlo simulation model, from a societal (base case) and National Health Service (NHS) perspective. New cases of HIV, AIDS and associated deaths in Spain were obtained from SINIVIH registry and UNAIDS. Local projections of new HIV cases, AIDS cases, and AIDS related deaths in a scenario without ART were estimated by triple exponential smoothing. HIV and AIDS cases averted and deaths prevented, were estimated. ART expenditure and the benefits of avoiding HIV infections and AIDS cases were obtained from National HIV plan assessment reports and Market Research data. The monetary value of a life was estimated as the local annual GDP per capita. The model’s assumptions and data were validated by a panel of 4 Spanish experts.

RESULTS: The NHS invested 6,185 million euros on ART over 32 years. In that period, 323,651 AIDS deaths, 500,129 AIDS cases and 161,417 HIV cases were averted, with total savings of 41,997 million euros. The net benefit (net savings) associated with these results is estimated at 35,812 million euros (social perspective) and 1,032 million euros (NHS perspective). ART is a profitable investment as it would render benefit/cost ratios of 6.79 (95%CI 5.39-8.35) and 1.17 (95% CI: 1.16; 1.18) from a social and NHS perspective, respectively. Subanalysis of ART drugs marketed by Gilead Sciences (2002-2018), brought out a net benefit of 8,361 million euros, 23% of the total (benefit/cost ratio of 3.2 from a social perspective).

CONCLUSIONS: The use of ART over 32 years in Spain has highly limited the amount of deaths from AIDS as well as new cases of both HIV and AIDS, while simultaneouly providing significant economic savings.