Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
Huge cost calculated for early treatment of AIDS
San Francisco Chronicle - Friday, September 15, 1989
Elaine Herscher, Chronicle Staff Writer
In the most far-reaching study to date, researchers warn that it will cost a staggering $5 billion a year to treat everyone infected with the AIDS virus who can benefit from early care. "Unless policymakers, public health and medical leaders plan now, early intervention will only invite further chaos and disarray in the U.S. health-care system," said Dr. Philip Lee, director of the Institute for Health Policy Studies at the University of California at San Francisco. Lee is co-author of an article in today's issue of the Journal of the American Medical Association warning that the country's health-care system is ill-prepared financially and physically to offer the kind of early intervention that will save lives. The report's authors said their study contains the most detailed calculations yet made of the national cost of early treatment of HIV disease and is the first to be published in a major medical journal. The study concludes that it will cost $5 billion to treat about half the estimated 1 million people infected with the human immunodeficiency virus, which causes AIDS. That figure is about double what is currently spent nationwide treating full-blown AIDS. The national Centers for Disease Control in Atlanta calculates that the rest of those infected have immune systems that are not weak enough to warrant treatment. In San Francisco, the cost this year of early intervention for half of those infected would be $103 million. In New York it would be $786 million. The treatment costs are not actually that high because many of those infected have not been tested and do not know they carry the virus. Also, many who test positive have not sought treatment. Manageable Illness The authors assert that HIV disease could eventually become a manageable chronic illness because of new anti-viral therapies, such as AZT and aerosol pentamidine, which delays Pneumocystis carinii pneumonia, the most common infection associated with AIDS. Studies show that many people carry the virus for longer than 10 years before becoming ill. Last month, a federal study concluded that AZT could slow the onset of AIDS in HIV-infected people who have no symptoms. However, the good news about early treatment is tempered with sobering figures on what such treatment would cost for a health-care system already in crisis nationwide. Pretreatment of HIV-infected patients averages $854 a year for laboratory tests, doctor's visits and counseling. But once a patient's health warrants drug therapy, the cost rises to $9,637 a year. The authors argue that not only must the federal government assume a greater economic burden, but drug companies must lower the price of prescription drugs that keep the virus at bay. "The bulk of the financial problem is due to the inflated cost of life-prolonging drugs," the study says. AZT costs $8,000 a year for the full dose, and because the manufacturer, Burroughs Wellcome, has been able to sell it without price constraints, the value of stock for its parent company has quadrupled, the researchers say. The price of pentamidine has risen from $24.95 per vial in 1984 to $99.45 in 1987, a 400 percent increase. System Not Working "This is a case study about how the health-care system in this country is simply not working for many people, and the way we develop and pay for prescription drugs isn't working, and the way we're pitting the public good against private gain isn't working," said co-author Pat Franks, a health policy analyst for the UC Institute for Health Policy Studies. The other authors are health economist Peter Arno and Douglas Shenson of the department of epidemiology and social medicine at Montefiore Medical Center/Albert Einstein College of Medicine; and Naomi Siegel of the department of health policy administration at the University of North Carolina. The researchers also say current services for testing, counseling, dispensing drugs and laboratory monitoring are "inadequate." San Francisco's health-care system is already overwhelmed with emergency rooms and outpatient clinics turning patients away because of too little money and too few care givers. Hundreds of thousands of additional patients seeking early treatment would be "mind-boggling," said Diane Miller, senior assistant administrator at San Francisco General Hospital. "I don't believe that we have the ability in the health-care system in San Francisco right now to accommodate the number of outpatient visits unless there's a dramatic change in the way we deliver care," Miller said in response to the study. Miller said that means that hospitals without HIV clinics need to open them, and existing clinics have to be open evenings and weekends. "It's not just a matter of financing. It's a matter of us being able to have the health-care system up and ready to respond," she said.
Keywords: AIDS; REPORT; COST; FINANCE; PHILIP LEE
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