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


  • Marlène Guillon

    () (Université Clermont Auvergne, CNRS, CERDI and Paris School of Economics)

  • Michel Celse

    (Conseil National du Sida-French National AIDS Council)

  • Pierre-Yves Geoffard

    (Paris School of Economics)


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.

Suggested Citation

  • Marlène Guillon & Michel Celse & Pierre-Yves Geoffard, 2018. "Economic and public health consequences of delayed access to medical care for migrants living with HIV in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(3), pages 327-340, April.
  • Handle: RePEc:spr:eujhec:v:19:y:2018:i:3:d:10.1007_s10198-017-0886-6
    DOI: 10.1007/s10198-017-0886-6

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    References listed on IDEAS

    1. Florence Jusot & Jérôme Silva & Paul Dourgnon & Catherine Sermet, 2009. "Inégalités de santé liées à l'immigration en France. Effet des conditions de vie ou sélection à la migration ?," Revue économique, Presses de Sciences-Po, vol. 60(2), pages 385-411.
    2. Keygnaert, Ines & Guieu, Aurore & Ooms, Gorik & Vettenburg, Nicole & Temmerman, Marleen & Roelens, Kristien, 2014. "Sexual and reproductive health of migrants: Does the EU care?," Health Policy, Elsevier, vol. 114(2), pages 215-225.
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    More about this item


    HIV/AIDS; Migrant populations; France; Access to care; Public policy;

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private


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