Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
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Miami Herald - Wednesday, June 7, 1989
Rosemary Goudreau, Herald Staff Writer
By conservative estimates, the new care strategy will cost $2 billion a year, but it is expected to save lives and save far more than $2 billion on hospital bills.
This major new policy recommendation from the U.S. Public Health Service, to be released in the next few weeks, is aimed at preventing pneumocystis carinii pneumonia in people infected with the human immunodeficiency virus. The pneumonia is a major cause of death in AIDS patients.
The government is going to call for HIV-infected people to get their blood tested every six months and when certain white blood cells called T-4 lymphocytes drop below a count of 200, to begin treatment with aerosol pentamidine.
The antiviral drug can prevent the deadly pneumonia, and so, prolong life, said Assistant Secretary of Health Dr. James O. Mason, speaking Tuesday at the Fifth International Conference on AIDS.
It is not known for how long the drug will prolong life, but between 5 and 20 percent of people die from the first bout of AIDS pneumonia.
This is the first drug treatment recommended for HIV-infected people who have no symptoms. But clinical trials are under way to determine if AZT can delay the progression of HIV infection.
The federal government estimates between one million and 1.5 million Americans are believed to be infected with HIV. About 200,000 are believed to have blood counts that would make them eligible for treatment with aerosol pentamidine. It takes between five and six years after infection with the virus for T-4 cell counts to drop to 200, according to research presented Tuesday from Walter Reed Army Institute of Research.
The new guidelines are expected to increase the demand for testing and the demand for medical services by HIV-infected people who currently have no symptoms.
Where the money will come from to meet the demand is not known.
"I hope there will be a way found so no citizen of the United States will find it necessary to go without effective drugs that can prolong life and productivity," Mason said.
The drug, still considered experimental but which doctors have been prescribing for a couple of years under an investigatory drug program, is expected to cost about $100 a month when licensed for use in the near future. It is given once a month with an inhaler, similar to asthma drugs.
To that $1,200-a-year drug cost, add the price of the T-cell tests every six months -- between $100 and $250 each. Along with the initial antibody test, counseling, doctor's visit and follow-up visits -- which adds another $250 or so -- the total per-person cost for the new treatment comes to about $2,000 a year.
If only the 200,000 believed to meet the criteria follow through, and if the other 1.2 million people believed infected are tested, the first year cost would be about $1 billion.
The average hospital bill for treatment of pneumocystis is between $10,000 and $15,000, researchers have reported.
Rep. Henry Waxman, D-Calif., who chairs the House Subcommitte on Health and the Environment, said Tuesday, "It's not enough to advise people to get the test and treated if they can't afford the tests or treatment.
"The public health experts should be talking to the budget makers now to explain that we need millions today for T-cell tests and preventive drugs and that we may save hundreds of millions tomorrow in hospital costs," Waxman said.
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