Wall Street Journal - Monday, 27 January 1997.
Laurie McGinley, Staff Reporter of The Wall Street Journal

Two studies show that the treatments, which combine new protease inhibitors with older AIDS drugs, reduce the use of hospitals and other expensive services. One of the studies also shows that the cost reduction is more than enough to make up for the expense of the drugs, which can easily cost $12,000 a year a patient. The information gives AIDS activists a potent weapon in their effort to win increased state and federal funding for the drug "cocktails."

The most striking findings, presented at the Fourth Conference on Retroviruses and Opportunistic Infections, came from Tower Infectious Disease Medical Associates, a large Los Angeles medical practice with about 480 AIDS patients. Researcher Peter Ruane found that each dollar of increased spending on drug therapies generated at least twice that in savings in overall treatment costs because of an improvement in patient health and a drop in AIDS-related infections.

Overall, Dr. Ruane found that the cost of treating AIDS patients fell 20% to 30%, even for the most advanced cases. New data by Saint Vincents Hospital and Medical Center in New York bolstered Tower's study, finding that the therapies reduced hospitalizations while increasing the demand for outpatient services.

"This will be very helpful in making the case that we should be making a large societal investment in providing these therapies," said Spencer Cox, director of the antivirals project at the Treatment Action Group, an AIDS advocacy group based in New York. "Because everyone is in balanced-budget mania, these data become vital."

The findings come at a crucial time. State AIDS drug-assistance programs, which receive federal funding to help uninsured, low-income patients buy medicine, are struggling to keep pace with the cost of the new treatments. Some of the states haven't even added the protease inhibitors to their list of approved drugs. Other states may institute waiting lists as cash runs short. "I'm certainly going to be using this data on Capitol Hill in the next few weeks" to argue for more funding, said Gary Rose, treatment and research coordinator for AIDS Action Council, which is based in Washington.

Still, the activists and the researchers themselves cautioned that it is too soon to know whether over the long term, the new drugs will be effective or what their impact on the health-care system will be. Some patients don't respond to the treatments; others can't tolerate the side effects. And the studies released yesterday were limited in their scope; most of the patients in the Tower study, for example, were white males who rigorously complied with the complicated drug regimen.

Three protease inhibitors currently are on the market: Merck & Co.'s Crixivan; Abbott Laboratories' Norvir and Roche Holding Ltd.'s Invirase. But more protease inhibitors are on the way, including Agouron Pharmaceuticals Inc.'s Viracept.

Dr. Ruane of Tower reported that between 1994 and 1996, the average number of days spent in hospitals each month by the practice's patients fell 57%, while the average number of skilled-nursing or days spent in hospices fell 65%. Use of home-care services also plummeted. At the same time, the use of protease inhibitors more than doubled total medication costs in 1996 compared with 1994 and more than quadrupled for patients with the most advanced disease.

The Saint Vincents study showed that between 1995 and 1996, the monthly average number of hospitalized patients with AIDS declined 24%, while the average length of stay fell 16%. At the same time, the number of HIV-infected individuals seeking outpatient care rose sharply.

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