OBJECTIVES: Alzheimer's disease (AD) has a significant economic impact on patients, caregivers, and healthcare payers. Medicare and Medicaid were estimated to cover $205 billion for AD and other cognitive disorders in 2022. Patients' out-of-pocket expenditure was projected to be $81 billion. As for caregivers, the hours of unpaid care and the value of unpaid care reached 16,023 hours and $271,598 million in total in the US. The significant burden of illness for AD and cognitive disorders makes timely diagnosis crucial in disease management. It allows healthcare providers and patients to employ strategies earlier to slow disease progression and reduce disease burden. People living with HIV (PLWH) are at higher risk of developing AD earlier because of HIV infection. This study aimed to evaluate the cost-effectiveness of implementing annual routine cognitive assessment in PLWH aged 50.

METHODS: We built a Markov model with six health states (normal, mild cognitive impairment (MCI), AD, diagnosed MCI, diagnosed AD, and death) and cognitive assessment as a tunnel state. Inputs for transition probabilities, costs, and utilities were sourced from published literature. Uncertainty was addressed by sensitivity analyses. The model adopted the societal perspective. Finally, we applied a 3% annual discount rate and reported costs in 2021 USD.

RESULTS: Over 25 years, the population receiving annual routine cognitive assessment gained 0.29 more quality-adjusted life years (QALYs). The incremental cost was $13,949, leading to an incremental cost-utility ratio (ICUR) of $48,635.

CONCLUSIONS: Implementing annual routine cognitive assessment in PLWH aged 50 is cost-effective compared to a willingness-to-pay threshold of $50,000.