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"If they rely on outdated cost information, treatment programs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.
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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