Cost Considerations for Rapid Start Implementation: Analysis from Seven Rapid Start Provider Sites

Antiretroviral treatment (ART) initiation within days of HIV diagnosis, also known as "Rapid Start", improves linkage to care, virologic suppression and retention in care. However, data on the costs of Rapid Start implementation in the United States are limited. We aimed to estimate the costs and cost-effectiveness of Rapid Start among seven geographically diverse Ryan White-funded programs with broad variability in populations served and services offered. Each site estimated the costs of ART initiation services, management, and Rapid Start planning activities in three 12-month periods: pre-, initial, and sustained implementation. We estimated quality-adjusted life years (QALY) saved, incremental costs per-person and incremental cost per QALY saved during implementation. We considered an intervention cost-effective if it cost <$76,399 USD per QALY saved (US per capita GDP, 2021). The number of persons initiating ART increased at most sites during implementation, which, together with assumed shorter times to viral suppression contributed to QALYs saved. Pre-implementation, the per-person cost of ART initiation and Rapid Start planning ranged from $549-$30,626, which declined at most sites during implementation. Incremental costs per-person ranged from a cost savings of -$21,284 up to $23,850 additional costs during the initial year and from $24,303 savings up to $11,774 additional costs during sustained implementation. The cost-effectiveness threshold was met by five sites during initial implementation and by all seven during sustained implementation. In conclusion, we demonstrated that Rapid Start was cost effective across a wide range of clinical settings, further bolstering this model's importance in ending the HIV epidemic.