A Linkage to HIV Care Cost Benefit Analysis Model:

From Cost Implications to Quality of Life Impact Webinar conducted by: HealthHIV, John Snow, Inc. (JSI), & SC Department of Health and Environmental Control (DHEC) Wednesday, January 13th, 2016 1:00pm - 2:00pm ET

HealthHIV Core Capabilities Capacity Building

Health Services Research & Evaluation

Advocacy

Education & Training

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Diverse staff of professionals with HIV, HCV, and LGBT clinical, global, cultural competency, prevention, and other experience – particularly within LGBT and other underserved communities

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Numerous strategic partnerships with national and local organizations (non-profit, clinical, behavioral, political, and technological)

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HealthHIV CBA Programs

ASO/CBO Capacity Building

HIV Prevention Technical Assistance

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Health Department Capacity Building

Health Center Capacity Building

Workforce Capacity Building

Retention in Care Institute

PatientCentered HIV Care Model

Municipal Leadership Capacity Building

Approach of Three D HIV Prevention Program •  Facilitate community infrastructure development and systems coordination to ensure sustainability of HIV services •  Expand care team integration through partnership development to include non-clinical HIV prevention partners •  Demonstrate cost effectiveness and outcomes monitoring of programs to maximize strengths and efficiencies and impact health outcomes •  Promote workforce development, including training the next generation of leaders in HIV prevention

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Available for Download Following the webinar today: •  PPT Slide Deck •  Webinar Recording •  Q&A www.HealthHIV.org/resources/webinars

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Instant Polling & Chat Box •  Multiple Choice Polling

•  Chat Box

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Introductions •  Marissa Tonelli, Senior Capacity Building Manager, HealthHIV •  Alexia Eslan, Senior Consultant, JSI •  Karen Schneider, Senior Research Scientist, JSI •  Monetha Gaskin, HIV Linkages/Data to Care, Program Coordinator, SC DHEC © 2016 HealthHIV

A Linkage to HIV Care Cost Benefit Analysis Model:

From Cost Implications to Quality of Life Impact Webinar conducted by: HealthHIV, John Snow, Inc. (JSI), & SC Department of Health and Environmental Control (DHEC) Wednesday, January 13th, 2016 1:00pm - 2:00pm ET

Webinar Objectives •  Review two versions of a Linkage to Care Cost Benefit Analysis model developed by JSI •  Provide an example of how the SC Department of Health and Environmental Control (SC DHEC) used the first model and outcomes to date •  Seek feedback from webinar participants on their needs for a cost benefit model

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Poll & Chat •  Instant Polling Question 1 •  If you answered yes to the poll question, what was the focus of the cost benefit analysis? Please respond in the chat box.

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Background on the Model •  SC DHEC was awarded a CDC Category C demonstration project in 2011 to: o  Increase linkages to HIV care and treatment to 85% in 2015 from 48% in 2011; and o  Decrease the proportion of people living with HIV who are out of care to 20% or less.

•  SC DHEC requested assistance from JSI to develop a cost-benefit model that would help evaluate the impact of their project

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HIV LINKAGE TO CARE COST BENEFIT MODEL

Why Model… •  Synthesizes data from many sources •  Allows for comparison of early versus late linkage •  Summarizes complex issues in systematic, transparent way •  Modeling helps organizations evaluate their programs and helps illuminate planning and programmatic decisions

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Objectives of SC Cost Model •  JSI helped SC DHEC to develop a cost analysis model to measure the following: -  Costs of getting persons linked to care early (within 90 days of diagnosis) versus late -  Cost savings associated with the number of HIV infections averted

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Methods •  Conducted a literature review -  Identified measures used to determine cost savings for early intervention and linkage to care

•  Developed a draft cost analysis model in Excel •  Reviewed model with SC DHEC and their CDC project officer and medical consultant -  Further, reviewed by CDC economist

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Questions Answered by Model •  What are the outcomes for linking individuals newly diagnosed with HIV to care within 90 days of their diagnosis? •  How would these outcomes differ if the individuals were linked to HIV care late after diagnosis (greater than 90 days)? •  How many new infections will be averted by early linkage of people diagnosed with HIV?

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Inputs

•  Number of newly diagnosed patients linked to HIV care within 90 days •  For Model 2: can also enter CD4 count upon entry into care for those newly diagnosed and linked to HIV care within 90 days •  Enter overall number or number by site

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Outputs •  •  •  •  •  •  •  • 

Lifetime costs Quality adjusted life years (QALYs) lost Additional life expectancy (in years) Onset of AIDS (in years) Duration on ART regimens (in years) Lifetime transmission Incremental cost effectiveness ratio (ICER) Outputs compared for early vs. late linkage

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Assumptions •  Outputs estimated based on CD4 count of those entering care, either entered by user or assumed as... -  For early linkage: 43% have a CD4 count 350-499 and 57% have a CD4 count 500+ -  For late linkage: nearly 2/3 have a CD4 count