Early treatment access called cost-effective
Early treatment access called cost-effective
Study challenges government assumptions
A new economic study presented at the 12th World AIDS Conference shows that early access to treatment for poor and uninsured HIV-positive people is so cost-effective that Medicaid could feasibly change its criteria for treating people infected with the virus.
"At the most basic level, our research shows that patients receiving early, aggressive treatment experience increased life span," says Gary Rose, public policy director and community liaison with the Treatment Access Expansion Project (TAEP). "Moreover, the overall cost of providing patients with this survival benefit is negligible."
Vice President Al Gore requested that federal health officials determine the feasibility of expanding Medicaid coverage to make new AIDS drugs available for people who are HIV-positive but have not progressed to AIDS. The Clinton administration, however, announced in December that expansion would be too costly.
The research, conducted by a consortium of academic researchers, professional pharmacoeconomists, AIDS organizations, and TAEP, was funded by Hoffmann-La Roche in Nutley, NJ.1
Specifically, the pharmacoeconomic study found that by delaying the onset of symptoms of AIDS, early treatment only slightly increases medical costs over the first five years, by $241 per patient per year, says John Hornberger, assistant professor of economics at Stanford University and a chief researcher for the study. Early treatment in patients currently infected but asymptomatic (having a CD4 count between 200 and 500 and never having an AIDS-defining event) was estimated to increase life expectancy by 0.43 years. The gain would result in longer treatment with protease inhibitors and increase lifetime expenses by 2.2% per patient. On the other hand, early treatment was projected to delay progression to AIDS and prolong survival at a cost that was within the range of generally accepted cost-effective medical interventions, he adds.
While the analysis is dependent on various assumptions about the impact of antiretroviral therapy, the main factor in the model is not long-term durability of treatment, which remains unproved, but how it affects CD4 counts, Hornberger tells AIDS Alert.
In another study evaluating the impact of expanding Medicaid to cover HIV infection, researchers at the University of California at San Francisco compared projected outcomes with and without expanding Medicaid coverage over five years. Based on the efficacy of combination therapy shown in clinical trials, the analysis predicted that 37,100 people would enroll in an expanded program, 83% of whom would not have AIDS. Over a five-year-period, the expanded program would result in 5,200 fewer deaths and increase total life-years by 14,500 years.
An expanded Medicaid program would cost $1.3 billion over five years, but would save an estimated $765 million in other federal expenses related to treating AIDS. The authors conclude that the program is affordable, and budget neutrality could be maintained if expansion were accompanied by an 18% reduction in HIV drug prices for Medicaid.2
References
1. Hornberger J, Aledort J, Roth N, et al. Early treatment with highly active antiretroviral therapy is cost-effective compared to delayed treatment. Presented at the 12th World AIDS Conference, Geneva, Switzerland, June 28-July 3, 1998. Abstract # 44243.
2. Kahn J, Haile B, Chang S. Expansion of U.S. Medicaid system to cover HIV drugs will prevent thousands of deaths and AIDS diagnoses, and is affordable. Presented at the 12th World AIDS Conference, Geneva, Switzerland, June 28-July 3, 1998. Abstract # 44241.
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