Press Releases

2001 Releases

Medicaid Coverage for Anti-AIDS Drugs Would be Cost Effective

For immediate release:  August 31, 2001 

Boston, MA - People without health insurance who are HIV-positive cannot get Medicaid coverage for antiretroviral drugs, the so-called "AIDS cocktail," until they develop full-blown AIDS and become disabled as a result of their illness. A study by Bruce Schackman, Ph.D.,, at the Harvard Center for Risk Analysis, finds that such coverage of early treatment would be cost-effective. The study is published in the current edition of the American Journal of Public Health (

The study finds that the cost of providing early antiretroviral drug coverage would be $17,300 per Quality Adjusted Life Year (QALY) saved. A QALY is an academically-accepted standard measure that assigns a value not only to the number of years of life saved, but to the quality of life experienced during those years. At $17,300 per QALY, coverage for antiretroviral drugs for the uninsured is a more cost-effective use of resources than for many other drugs already covered by Medicaid both to AIDS patients (e.g. drugs for preventing an opportunistic infection, $38,000/QALY) and to non-AIDS patients (e.g. lipid-lowering drugs for men with high cholesterol, $54,000-420,000/QALY).

Under the Ryan White CARE Act, the federal government provides payments to states for antiretroviral drug coverage for uninsured people who are HIV-infected. But there is wide variability between states in the level of coverage offered. Some states (New York, Massachusetts) offer essentially full coverage. Other states offer far less coverage. In some states, hundreds of people who have HIV are on waiting lists for drugs that could delay the onset of AIDS, if those drugs are administered in time. And the federal funds available to the states contribute to the cost of the drugs, but not the doctor visits necessary to get the drugs prescribed, or to monitor and adjust their use. The study estimates that early treatment increases government health care costs by $11,500 per patient compared to delayed treatment in the first five years, after taking into account additional drug costs and savings from fewer AIDS complications.

"Adding coverage will increase costs in the near term," Schackman says. "But these findings provide a strong argument that Medicaid money to help people who are HIV-infected can be better spent if the program is adjusted to include coverage for the uninsured before they get sick.." Schackman is now at the Weill Medical College of Cornell University. He did the study, along with co-authors Drs. Sue Goldie, Milton Weinstein, Elena Losina, and Kenneth Freedberg, when he was with the Harvard Center for Risk Analysis, part of the Harvard School of Public Health.

The study was funded by grants from the National Institute of Allergy and Infectious Diseases and the National Library of Medicine and by cooperative agreements with the Centers for Disease Control and Prevention.

The Harvard Center for Risk Analysis is supported by funds from government, industry, and academia. Further information about the Center is available at

For further information, please contact:

Contact: Bruce Schackman
Weill Medical College,
Cornell University
(212) 746-6625

Robin Herman
Harvard School of Public Health