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

Area of Science:

• Public Health
• Health Economics
• Infectious Disease Management

Background:

• Antiretroviral treatment (ART) initiation shortly after HIV diagnosis, known as Rapid Start, enhances patient care outcomes.
• Limited data exist on the economic implications of implementing Rapid Start programs in the United States.
• Understanding the costs and cost-effectiveness is crucial for widespread adoption and public health policy.

Purpose of the Study:

• To estimate the costs and cost-effectiveness of implementing Rapid Start HIV treatment programs.
• To analyze these costs across diverse Ryan White-funded healthcare settings in the US.
• To assess the impact on quality-adjusted life years (QALYs) and per-person costs.

Main Methods:

• Cost analysis of ART initiation and Rapid Start planning over three 12-month periods (pre-, initial, sustained implementation).
• Estimation of quality-adjusted life years (QALYs) saved and incremental costs per person and per QALY.
• Evaluation of cost-effectiveness against a threshold of <$76,399 USD per QALY saved.

Main Results:

• ART initiation increased at most sites, contributing to QALYs saved due to faster viral suppression.
• Per-person costs for ART initiation and Rapid Start planning decreased during implementation at most sites.
• Five sites met the cost-effectiveness threshold during initial implementation, and all seven met it during sustained implementation.

Conclusions:

• Rapid Start implementation was found to be cost-effective across diverse clinical settings.
• The strategy significantly improves patient outcomes, including linkage to care, viral suppression, and retention.
• Rapid Start is a vital model for advancing efforts to end the HIV epidemic.