Economic and public health consequences of delayed access to medical care for migrants living with HIV in France

Marlène Guillon, Michel Celse and Pierre Geoffard
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Marlène Guillon: CERDI - Centre d'Études et de Recherches sur le Développement International - UCA [2017-2020] - Université Clermont Auvergne [2017-2020] - CNRS - Centre National de la Recherche Scientifique
Michel Celse: Conseil National du Sida - French National AIDS Council - Conseil National du Sida - French National AIDS Council - Conseil National du Sida - French National AIDS Council

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Abstract: In 2013, migrants accounted for 46% of newly diagnosed cases of HIV (human immunodeficiency virus) infection in France. These populations meet with specific obstacles leading to late diagnosis and access to medical care. Delayed access to care (ATC) for HIV-infected migrants reduces their life expectancy and quality of life. Given the reduction of infectivity under antiretroviral (ARV) treatment, delayed ATC for HIV-infected migrants may also hinder the control of the HIV epidemic. The objective of this study is to measure the public health and economic consequences of delayed ATC for migrants living with HIV in France. Using a healthcare payer perspective, our model compares the lifetime averted infections and costs of early vs. late ATC for migrants living with HIV in France. Early and late ATC are defined by an entry into care with a CD4 cell count of 350 and 100/mm3, respectively. Our results show that an early ATC is dominant, even in the worst-case scenario. In the most favorable scenario, early ATC generates an average net saving of €198,000 per patient, and prevents 0.542 secondary infection. In the worst-case scenario, early ATC generates an average net saving of €32,000 per patient, and prevents 0.299 secondary infection. These results are robust to various adverse changes in key parameters and to a definition of late ATC as an access to care at a CD4 level of 200/mm3. In addition to individual health benefits, improving ATC for migrants living with HIV proves efficient in terms of public health and economics. These results stress the benefit of ensuring early ATC for all individuals living with HIV in France.

Keywords: Public policy; Access to care; France; HIV/AIDS; Migrant populations (search for similar items in EconPapers)
Date: 2018-04
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Published in European Journal of Health Economics, 2018, 19 (3), pp.327-340

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Related works:
Journal Article: Economic and public health consequences of delayed access to medical care for migrants living with HIV in France (2018)
Working Paper: Economic and public health consequences of delayed access to medical care for migrants living with HIV in France (2018)
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