Researchers Project Lifetime Cost and Life
Expectancy for Current HIV Care in the United States
http://news.med.cornell.edu/wcmc/wcmc_2006/11_01a_06.shtml
NEW YORK (November 1, 2006) — "The Lifetime Cost of Current
HIV Care in the United States," a major study appearing in the
November 2006 issue of Medical Care, projects the cost of
treatment for HIV-infected adults using current standards of care.
The study provides guidance for policy makers so that appropriate
funds are allocated for HIV care and prevention.
"Policy makers need accurate and up-to-date predictions of the
future expense of HIV treatment if they seek to ensure broad access
to high-quality care," says lead author Dr. Bruce R. Schackman,
Chief of the Division of Health Policy in the Department of Public
Health at Weill Cornell Medical College. "If they rely on outdated
cost information, treatment programs will be under-funded and the
economic value of HIV prevention will be understated."
Dr. Schackman and Dr. Kenneth A. Freedberg, Director of Epidemiology
and Outcomes Research at the Partners AIDS Research
Center/Massachusetts General Hospital (PARC/MGH), collaborated on
the study with Drs. Kelly A. Gebo and Richard D. Moore from the
Department of Medicine at Johns Hopkins University School of
Medicine, along with colleagues at PARC/MGH, Harvard School of
Public Health, Harvard Medical School, and Boston University School
of Public Health.
The authors estimated the monthly medical cost for people with HIV,
from the time of beginning appropriate care until death, to be
$2,100 on average. The projected life expectancy for these
individuals, if they remain in optimal HIV care, has now increased
to 24.2 years, and the lifetime per person HIV care cost is now
$618,900 per person. This amount is comparable to the estimated
lifetime medical cost for women under age 65 in the U.S. with
cardiovascular disease, who can also have long life expectancies
with appropriate medical management. When HIV care costs are
discounted to reflect the fact that they will be incurred in the
future, the projected lifetime cost per person at the time of
entering optimal HIV care is $385,200, and the treatment expense
that can be avoided by preventing each HIV infection is $303,100.
The authors used a computer simulation model to project HIV medical
care costs. Information on medical visits and hospitalizations came
from the HIV Research Network, a consortium of high-volume HIV
primary care sites in the US, and data on the efficacy of HIV
treatment drug regimens were from other published studies.
"Since combination therapy was introduced in 1996, there has been a
dramatic increase in the life expectancy and quality of life of
individuals in the U.S. infected with HIV," says Dr. Freedberg. "As
effective regimens have substantially improved survival, they have
also increased the lifetime cost of HIV-related medical care."
The authors found that today, medications make up more than 70
percent of the expense of HIV treatment. Before combination therapy
was introduced, HIV treatment usually consisted of one or two drugs.
Today, there are 24 drugs in four different drug classes, and drugs
are selected using sophisticated tests for drug resistance that were
unavailable in the mid-1990s.
At the same time, hospitalization rates have declined as a result of
these effective therapies. A 1993 estimate of the life expectancy
for an HIV-infected adult without symptoms was 6.8 years, and
approximately 50 percent of the future cost of care for this
individual was expected to be for hospital stays while only 14
percent would be for medications.
"While federal government spending on HIV-related medical care in
the U.S. has tripled during the past 10 years, cost considerations
still limit access to HIV care," says Dr. Moore. "Access to HIV care
may become increasingly difficult unless more government funds
become available or the cost of HIV care is reduced. Since the major
portion of all HIV treatment costs now comes from antiretroviral
drugs, further scrutiny of drug pricing is to be expected."
The Centers for Disease Control and Prevention (CDC) estimate that
about 40,000 people become infected with HIV every year in the
United States. Under current care standards, these infections will
result in $12.1 billion annually in future treatment costs. Although
those who avoid HIV infection will eventually incur medical costs
for other diseases, the financial burden of most non-HIV diseases
occurs much later in life. The study therefore demonstrates that
greater investments in evidence-based HIV prevention activities are
clearly needed, as well as appropriate funds to treat people who are
infected.
The CDC also estimates that 250,000 people with HIV in the U.S. —
one-fourth of the total with HIV — do not know that they are
infected. New CDC guidelines released in September 2006 recommend
making HIV testing a part of routine medical care, with the goal of
identifying these people so that they can get care early and avoid
transmitting HIV. If this important public health goal is reached,
even more funds will be required to treat these newly identified HIV
patients.
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The study was supported in part by the National Institute of Allergy
and Infectious Diseases, the National Institute on Drug Abuse, and
the Agency for Healthcare Research and Quality.
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Contact Info
Jonathan Weil
jweil@med.cornell.edu
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