AIDSWEEKLY Plus; Monday, September 7 & 14, 1998
Daniel J. DeNoon, Senior Editor
Highly active antiretroviral therapy (HAART) - now the standard of care for the industrialized world - has greatly reduced AIDS incidence. And while HAART isn't cheap, its cost is far less than the cost of treating AIDS.
"HAART is arguably the most cost-effective major new medical technology that has been introduced in the past decade," say John G. Bartlett and colleagues.
The Johns Hopkins researchers reported the results of a cost/effect study of HAART in clinical practice at the 12th World AIDS Conference, held June 28-July 3, 1998, in Geneva, Switzerland.
Short-term savings from HAART are significant, they found, and clinical outcomes are substantially improved. And predicted long-term savings are impressive.
"In the longer term, we project an incremental cost-effectiveness ratio that is highly favorable compared to almost any other technology in the U.S.," Bartlett et al. forecast.
The study compared 606 patients followed at the Johns Hopkins clinic in Baltimore from 1994-5 - before HAART was available - to 302 patients treated from 1996-7. Measures included incidence of opportunistic infections, survival, rates of progression to AIDS from a starting CD4 count of 200-500 cells/(micro)L, and length of survival between these two times. Evaluation of medical costs included acute and chronic hospitalization, outpatient visits, pharmacy costs, and home-health-care costs.
By all estimates, the HAART patients did better:
* The rate of progression to AIDS decreased by 12 cases per 100 person-years.
* The mortality rate decreased by 5 deaths per 100 person-years.
* Total medical costs decreased: by $3384 per person with a starting CD4 count of more than 200 cells/(micro)L, and by $2868 per person with a CD4 count of less than 200 cells/(micro)L.
* Projected savings over five to 10 years are $1400 to $2800 per AIDS case averted. Assuming HAART's beneficial effects last for five years, starting HAART when a patient's T-cell count is 200-500 cells/(micro)L would save $5000 to $8000 per year of life.
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