Miami Herald; Monday, November 25, 1991
Elinor Burkett, Herald Staff Writer

Lesson No. 2 will come with the bill for the AZT he began taking last week: Not everyone can afford it.

"Even with medical insurance, getting the treatments you need and the drugs you want is astronomically expensive," says Dr. Peter Arno, a health economist at Montefiore Medical Center in New York. "It's not just the doctors' visits, lab tests and drugs. It's paying for all the treatments insurance doesn't cover. It's flying around the world to get them."

"Johnson's lucky he's a multimillionaire. HIV is not for the poor."

What will it cost Magic Johnson -- and his insurance company, Prudential -- to keep the athlete healthy as long as possible?

Treatment to keep the HIV-infected from falling ill averages about $9,637 per year, according to Arno, one of the few economists in the country who are studying the cost of AIDS. In South Florida, however, several well-insured AIDS patients are paying thousands more.

Take Jim Pruitt, diagnosed with the AIDS virus in 1985. He survives using the strategy most physicians have mapped out for the HIV-infected: aggressive preventive treatment to keep him from falling ill with one of the two dozen cancers, viral infections, parasites or bacteria that kill people with damaged immune systems.

Pruitt visits his doctor once a month: $75. His blood is tested every other week to ensure that any potentially life-threatening problem is spotted early: $485. He takes medications to help prevent every disease that's currently preventable:

AZT or DDI to slow the growth of the virus: $2,000 to $3,000 a year.

The antibiotic Bactrim or inhalation therapy with aerosolized pentamidine to prevent pneumonia, the biggest killer of people with AIDS: $100-$3,000 a year. (Bactrim costs $100, but most patients are on pentamidine, at $3,000, because Bactrim is difficult to take.)

Acyclovir to prevent cytomegalovirus: $6,630 a year.

Diflucan to kill candida, a fungal infection, and prevent meningitis: $4,015 a year.

Human immunoglobulin to improve the quality of blood and prevent bacterial infection: $16,800.

Last year, keeping Pruitt well cost his insurance company $38,900.97. Thus far this year, the tab is $35,024.18.

That's a fraction of what it will cost if Pruitt becomes actively ill and is forced into the hospital. Ask Drew Averat of Fort Lauderdale. On Oct. 29, he was released from a 20-day stay in South Miami Hospital, where he was treated for parasites, a kidney infection and suspected cytomegalovirus. The average AIDS patient spends about 22 days a year in the hospital, according to Dr. Fred Hellinger, a health economist for the U.S. Department of Health and Human Services.

Averat's hospital bill: $54,926.30. The physicians' bills haven't come in yet.

Early in the epidemic, when doctors had few weapons against the AIDS virus and the rare diseases afflicting the infected, economists estimated AIDS patients' treatments would run $30,000 to $40,000 over the course of their short, post-diagnosis lives. But as new drugs have been added to the bill, converting AIDS into a chronic illness, the tab has skyrocketed. The latest estimate from Hellinger: $85,333.

Many think even that figure is too low, skewed by the growing number of people who die too quickly to accumulate many bills.

"We don't believe the $85,000 figure," said Robert Padgug, director of health policy for Empire Blue Cross/Blue Shield, the nation's largest private insurer of AIDS patients and one of the few to have calculated what AIDS is costing it.

"We estimate the costs to be $150,000 from diagnosis with AIDS to death. But even that isn't complete. It doesn't include all the treatment we simply don't cover. It doesn't include the years of treatment after infection and before AIDS," in other words, the costs now faced by Magic Johnson.

Empire's estimate for AIDS puts it in the cost range of a liver transplant, for example, with a lifetime treatment cost of $145,000. The lifetime cost of treating a breast cancer patient, by contrast, is $52,000.

The primary inflation in the HIV and AIDS bill is drugs, some of the most expensive pharmaceuticals in the history of the country. When AZT went on the market in 1987, it cost $12,000 a year. The latest AIDS drug, foscavir -- used to treat cytomegalovirus -- was just released at $22,000 a year. Both drugs are prescribed for life.

The cost of medication for the HIV-infected has provoked fury among the nation's highly politicized AIDS patients. Drug industry representatives have defended medication prices, citing the high cost of development. In 1991 alone, pharmaceutical companies will spend an estimated $9 billion in research and development. Still, a recent report from the U.S. Senate Special Committee on Aging notes that the drug industry's annual average profit margin -- 15.5 percent -- is triple the profit margin of the average Fortune 500 company.

Johnson, like Pruitt and Averat, can afford those drugs because he is privately insured. Most major insurance companies allow physicians latitude to prescribe expensive drugs for HIV and AIDS, even when the federal government has not approved them for HIV-related diseases. Fifty percent of the AIDS patients in Florida, however, are less fortunate: they depend on Medicaid.

Medicaid will pay for a drug only if it has U.S. Food and Drug Administration approval for the specific condition for which it is prescribed. Most importantly, says Pruitt, Johnson will be able to afford experimental treatments beyond the means of most people with HIV. With a relatively new disease like AIDS, the newest and most promising of drugs and therapies often are available only through clinical drug trials, in foreign countries where the approval process is often faster or through one of the numerous underground buyers' clubs that supply experimental drugs not otherwise available.

A recent study by researchers at the University of Illinois reports that more than one-third of the nation's AIDS patients are on some sort of unapproved therapy.

"If I had Magic Johnson's money, I'd be banging on every door to get some of the new antivirals, therapeutic vaccines or passive immunotherapy," says Pruitt. "But I can't afford to fly to California every month to be in clinical trials. I can't afford to pay $15, $20, $100 a day for the newest promising treatment. I can't fly to Europe to get drugs that have been approved there."

Few can. And even those who do end up with an enormous financial burden.

Before their two sons contracted HIV, Doris and David Feinberg lived comfortably -- and relatively debt-free -- in Miami Beach.

Then came the trips to New York for consultation with experts at the center of the epidemic, to Israel and Germany for drugs. Then came their share of the hospital bills, the blood tests, the physicians' fees.

By the time they buried their second son, Jeffrey, in spring 1990, they were $300,000 in debt.

THE COST OF STAYING WELL

Last year, Jim Pruitt's insurance company paid $38,900.97 for treatment of HIV infection. This treatment was exclusively preventive -- no hospitalization, no treatment for any AIDS-related disease. Following the widely accepted regimen for preventive treatment might cost up to $46,955. Here's how it breaks down:

* Monthly doctor's visits $75 $900

* Biweekly blood tests $485 $12,610

* AZT or DDI $2,000 to $3,000

* Bactrim or pentamidine $100 to $3,000

* Acyclovir $6,630

* Diflucan $4,015

* Human immunoglobulin $16,800

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