Newsday - March 15, 2001
Laurie Garrett, Staff Writer

If the price of anti-HIV drug cocktails was reduced significantly, to below $500 a year, the researchers said, they could prove cost- effective even for desperately poor African countries.

One study also concluded that the AIDS drugs are more cost- effective than customary treatments for several other diseases.

There are hints in the studies that more HIV patients in this country are needing hospital care, possibly as a result of long-term failure of the drugs.

"This [increasing hospitalization] trend warrants ongoing observation," writes a Rand Corp. research team. "If it is sustained, the increased use of hospital services probably reflects the aggregate effect of treatment failures due to viral resistance or drug intolerance.

"This possibility argues for further investments in treatment research and stands as a warning that the service capacity lost with the closing of HIV wards might be needed again."

The California-based Rand team, led by Dr. Samuel Bozzette, analyzed the treatment cost and outcomes of more than 2,000 patients a year, from June, 1996 to January, 1999. At the start of the study the average patient was spending $1,749 a month on HIV-related care. By October, 1998, that monthly expenditure had fallen to $1,503. The major cost saving was hospital care-the drugs kept patients healthy longer. So, even though HIV drugs cost about $10,000 a year in the United States, the net effect is a reduction in average annual medical costs.

Bozzette argued that the current available drug cocktails are giving HIV patients two to three years of additional life expectancy at a net cost of roughly $11,000 to $18,000 per year. If that individual is a productive worker, his or her contribution to society well exceeds those costs.

In the second study, using a complex computer model to calculate theoretical costs of treating 1 million Americans with the drug cocktails, a team of researchers from several Boston-area medical institutes led by Dr. Kenneth Freedberg of Harvard Medical School concludes the AIDS drugs are twice as cost-effective as radiation treatment for breast cancer, nearly three times more cost-effective than anti-lipid therapy to prevent heart disease and tenfold more cost-effective than dialysis therapy for kidney disease.

The Northeast, particularly New York and New Jersey, is the most expensive region for HIV care, Bozzette said in an interview, because "the Northeast is full of more expensive patients-minorities, IV drug users, women, impoverished." More of the patient population in the Northeast is drawn from the ranks of the poor, who tend to seek care only after their illnesses have progressed to advanced stages, which makes their treatments costlier.

Since such patients wind up using more hospital care later in their illness, "we do not save by skimping on drug therapy," Bozzette said.

Ultimately all HIV patients require expensive care as their disease accelerates, Freedberg said.

"People who are effectively treated will either continue on expensive [medications] for years, or fail with complications of HIV or hepatitis C or cardiovascular disease...[and] often have 'end- stage' costs," Freedberg explained in an interview.

Bozzette and Freedberg said everybody with moderate-to-advanced HIV disease should be on the drug cocktails, and the hefty price tags should be viewed, over time, as minimal.

New England Journal of Medicine editor Dr. Robert Steinbrook found the data sufficiently compelling to suggest immediate government policies aimed at increasing access to the therapies in the United States, further lowering the drug costs and expanding efforts to identify Americans who are unaware that they are infected, in order to get them onto anti-HIV drugs.

The researchers also insist these cost-effectiveness studies have implications for poor, AIDS-ravaged societies in sub-Saharan Africa.

"We can say that drug cost is the biggest driver of cost- effectiveness," Freedberg said, "so if drug costs are reduced by 95 percent, say to $500 per person per year in Africa, then we can be pretty sure that the cost-effectiveness ratio will be about $500 to $1,000 per year of life saved."

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