Expensive Multi-drug Treatment For HIV is Cost Effective
For immediate release: March 15, 2001
Boston, MA--Combination drug therapy for AIDS, despite its great expense, is a cost-effective use of resources, according to a study in the March 15 edition of the New England Journal of Medicine (www.nejm.com). Sue Goldie, M.D., M.P.H., of the Program for the Economic Evaluation of Medical Technologies (PEEMT), part of the Harvard Center for Risk Analysis, is senior author of the study. Milton C. Weinstein, Ph.D. Director of PEEMT, also participated in the work.
Three-drug antiretroviral therapies, or "HIV drug cocktails," have been demonstrated to be effective in suppressing HIV and preventing progression of AIDS-related diseases. But such treatment costs, on average, about $12,000 in wholesale costs per patient per year. Those high costs have raised questions about the appropriate use and financing of these medications.
The study used a comprehensive computer model of HIV disease developed by the team of researchers, led by Kenneth A. Freedberg, M.D., M.Sc,, of the Massachusetts General Hospital, Division of General Internal Medicine and the Partners AIDS Research Center. The model incorporates the most up-to-date data on HIV disease and therapy to simulate the disease progression of large populations of HIV-infected patients. Outcomes are represented in terms of patients’ average life expectancy, AIDS-related disease occurrences and total medical costs.
For patients with advanced AIDS, combination therapy was associated with a near doubling in life expectancy, from 1.53 years to 2.91 years when adjusted for quality of life, and with an increase in total medical costs from $45,000 to $77,000. This leads to a cost of $23,000 per quality-adjusted life year (QALY) saved. A QALY is a measure that takes into account not only increased longevity but the quality of that longer lifespan. $23,000 per QALY is roughly the amount currently invested in treatment of high blood pressure.
Freedberg, Goldie, Weinstein and colleagues demonstrate in the study that the high cost of treatment is more than balanced by the dramatic benefits for those living with HIV. They state, "Three-drug combination therapy can significantly increase life expectancy, decrease AIDS-related disease incidence, and quantifiably improve HIV patients’ overall quality of life — all for a very reasonable cost to society. The results of our analysis do not mean that HIV therapy will save money in the long run. Those who are living with HIV and on effective therapy will live longer, and thus overall costs will increase. Nevertheless, the price of three-drug combination therapy is an extremely good value compared with other ways we spend money in all areas of medicine."
The study was supported by the National Institute of Allergy and Infectious Diseases and the Centers for Disease Control and Prevention.
The Harvard Center for Risk Analysis (HCRA) is part of The Harvard School of Public Health. HCRA is supported by funds from government, industry, and academia. Further information about the Center is available at www.hcra.harvard.edu.
For further information, please contact:
Harvard Center for Risk Analysis
Harvard School of Public Health
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Boston, MA 02115