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Human immunodeficiency virus (HIV) infection and the resulting acquired immunodeficiency syndrome (AIDS) pose a significant global health crisis (1). The associated economic burden is substantial (2–3). In this study, using a Susceptible-Infected-Recovered-Deceased (SIRD) model and incorporating HIV epidemic surveillance data from Tianjin Municipality, China, we estimated the cumulative number of infections and deaths prevented, annual new infections, deaths, and the socioeconomic impact of HIV preventative and control measures in Tianjin from 2011 to 2022. The findings indicate that between 2011 and 2022, HIV prevention efforts may have averted a total of 2,965 infections and 658 deaths, leading to an economic benefit of approximately 14.437 billion Chinese Yuan (CNY). These outcomes underscore that effective prevention and control strategies have the potential to mitigate the spread of AIDS and lessen its economic impact.
The SIRD model was employed to segment the population into four distinct categories — susceptible (S), infected (I), recovered (R), and dead (D). This model was utilized to project the number of infections and deaths that would theoretically occur without the implementation of innovative and precise AIDS prevention and control measures. The simulations were based on transmission coefficients and mortality rates from 2010, which served as the baseline scenario. Following this, the actual outcomes were compared against the projections to estimate the annual number of new infections and deaths, as well as the aggregate reduction of infections and deaths, in Tianjin over the period from 2011 to 2022. Herein, ‘S’ represents the portion of the population who are healthy but lack immunity, while ‘I’ denotes individuals infected with HIV.
The model operates under the assumption that the transmission, recovery, and mortality rates remain constant over time. The system is described by the following set of differential equations.
$$ \begin{aligned}& dS/dt=-\lambda \times S \times I/N \\ & dI/dt=\lambda \times S \times I/N-\mu \times I-\delta \times I\\ & dR/dt=\mu \times I\\ & dD/dt=\delta \times I \end{aligned} $$ (1) Where N=8,730,300, is the total population aged 15 years and above in Tianjin in 2010, from the statistical yearbook. λ is the transmission coefficient, which is 0.25 (4). The recovery coefficient μ is 1–10, which we set to a very small value due to the fact that AIDS is almost incurable. δ is the mortality rate, which is 0.02 (5–6). Obtaining the baseline of AIDS in 2010 from the Networked Direct Reporting of Infectious Diseases (NDRID) system, where I(0)=786, R(0)=0, D(0)=2. The model assumes N=S+I+R+D.
Based on cost analyses conducted by real-world data measurements from designated medical institutions and the literature (7–8), the average annual outpatient expense for treating an AIDS patient is approximately 3,400 CNY in the initial year, with subsequent annual costs averaging around 1,600 CNY. Furthermore, patients receive two complimentary CD4 tests annually at a cost of 360 CNY, a viral load test provided without charge for 1,300 CNY, and free antiretroviral therapy drugs estimated to cost about 1,679 CNY per patient per year. When hospitalization is required for the treatment of opportunistic infections, the cost averages 25,570.5 CNY per admission. Prior research and evaluations by the designated medical institutions suggest that the average treatment duration needed for an AIDS patient in Tianjin spans approximately 15 years (9).
The formula for calculating the cost of state financial support and the cost of health insurance, individual outpatient treatment, and treatment of opportunistic infections saved by the prevention of new infections are as follows (10).
$$ \begin{aligned}{E}_{i1}= \;&{N}_{i}\times 15\;years\times (2\times CD4\;test+viral\;load\;test\;+\\ &antiretroviral\;therapy\;drugs)\end{aligned} $$ (2) $$ \begin{aligned}{E}_{i2}=\; &{N}_{i}\times (first\;year\;outpatient\;cost+14\;years\;\times \\ & follow\;up\;outpatient\;cost \;+\\ &average\;hospitalization\;cost)\end{aligned} $$ (3) $ {N}_{i} $ was the cumulative prevention of infections.The per capita GDP of Tianjin in 2011–2022 was 61,458.41 CNY, 66,517.25 CNY, 71,344.62 CNY, 74,960.34 CNY, 75,868.27 CNY, 79,647.47 CNY, 87,280.48 CNY, 95,688.65 CNY, 101,556.79 CNY, 101,614.21 CNY, 113,190.83 CNY, and 118,800.00 CNY. Concurrently, an analysis of the disability-adjusted life years (DALYs) per prevention in HIV infections was 31.05, 29.29, 30.78, 36.37, 41.80, 45.48, 46.76, 46.86, and 46.19 for 2011–2019 (11), and the 2020, 2021, and 2022 years using DALY 2019. The methodology utilized to calculate the economic benefits resulting from the reduction in new HIV infections
$ {E}_{i3} $ is as follows (12).$$ \begin{array}{c}{E}_{i3}=\displaystyle\sum\limits_{t=2011}^{2022}\left(DALY{s}_{t}\times {N}_{t}\times {\left(per\;capita\;GDP\right)}_{t}\right) \end{array} $$ (4) t denotes the year.
$ {DALYs}_{t} $ ,$ {N}_{t} $ ,${\left(per\;capita\;GDP\right)}_{t}$ were the DALYs, reduced infections, and per capita GDP in year t, respectively.Patients with AIDS and their families annually incur costs of 240.6 CNY for transportation, 88.44 CNY for accommodation, and 460.2 CNY for nutrition, respectively (13). The formula to calculate additional cost savings achieved by preventing new infections is provided in reference (10).
$$ \begin{aligned}{E}_{i4}=&{N}_{i}\times 15\;years\times (transportation\;cost\\ & +accommodation\;cost+nutrition\;cost)\end{aligned} $$ (5) The total economic benefit of reducing infections
$ {(E}_{i}) $ is calculated as follows.$$ \begin{array}{c}{E}_{i}={E}_{i1}+{E}_{i2}+{E}_{i3}+{E}_{i4}\end{array} $$ (6) Between 2011 and 2022, the life expectancy of AIDS patients increased by an average of 12 years. The Health State Utility (HSU) for AIDS patients undergoing antiretroviral therapy is valued at 0.82 (12). The average per capita GDP in Tianjin during this timeframe was 87,327.28 CNY. To calculate the economic benefits derived from the prevented deaths, subtract the cost of treatment and additional expenses incurred during the extended survival period, including transportation, accommodation, and nutritional costs, according to the formula presented in reference (10).
$$ \begin{array}{c}{E}_{d1}={N}_{d}\times average \;per\; capita \;GDP\times 12\; years\times DALY \end{array} $$ (7) $$ \begin{aligned} {E}_{d2}=\; & {N}_{d}\times 12\;years \times (Follow-up\;outpatient\;cost+2 \;\times\\ & CD4\;test+viral\;load\;test\\ &+antiretroviral\;therapy\;drugs)\end{aligned} $$ (8) $$ \begin{aligned}{E}_{d3}=\; &{N}_{d}\times 12\; years\times (transportation\;cost\\ &+accommodation\;cost+nutrition\;cost)\end{aligned} $$ (9) $ {N}_{d} $ was the cumulative effect on the prevention of deaths.The total economic benefit of reducing deaths
$ \left({E}_{d}\right) $ is calculated as follows.$$ \begin{array}{c}{E}_{d}={E}_{d1}-{E}_{d2}-{E}_{d3}\end{array} $$ (10) Considering the extended duration of the study, we conducted additional analysis on the economic advantages, applying an annual discount rate of 5% (14). All statistical analyses were conducted utilizing the Policy and Numpy packages in Python (version 3.8), complemented by the use of Microsoft Excel (version 2016, Microsoft Corporation, USA).
As shown in Figure 1, there is no significant difference in the number of infections per year during 2011–2013 compared to the actual situation. Infections prevented each year from 2014–2022 were 81, 147, 228, 337, 383, 442, 510, 213, and 612, respectively, with a total of 2,965 cases prevented from 2011–2022. Deaths prevented annually during the AIDS prevention and treatment program were 17, 22, 15, 11, 22, 34, 58, 68, 59, 87, 107, and 158, respectively, resulting in a cumulative prevention of 658 deaths over 12 years.
Figure 1.Annual prevention of infections and deaths and cumulative prevention of infections and deaths in Tianjin, 2011–2022.
As shown in Table 1, the economic benefits of prevented infections and deaths are valued at 13.920 billion CNY and 0.523 billion CNY, respectively.
Sources of economic benefits Economic benefits (billion CNY) Discounting (billion CNY) Infections $ {E}_{i1} $ 0.165 0.174 $ {E}_{i2} $ 0.152 0.160 $ {E}_{i3} $ 13.568 14.282 $ {E}_{i4} $ 0.035 0.037 Total 13.920 14.653 Deaths $ {E}_{d1} $ 0.565 0.595 $ {E}_{d2} $ 0.042 0.044 $ {E}_{d3} $ 0.006 0.006 Total 0.517 0.545 Abbreviation: HIV=human immunodeficiency virus; CNY=Chinese Yuan. Table 1. Economic benefits of HIV prevention measures in preventing infections and deaths with and without discounting in Tianjin Municipality, China, 2011–2022.
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