Treatment for HIV disease found cost effective

Three-drug combination therapy for AIDS, in spite of its great expense, is a very cost-effective use of resources, report researchers from Massachusetts General Hospital (MGH) and their colleagues. The study appears in the March 15 issue of the New England Journal of Medicine.

Three-drug antiretroviral therapies, or "HIV drug cocktails," have been demonstrated to be highly effective in suppressing HIV virus and preventing disease progression. However, the enormous costs of these drugs � averaging about $12,000 in wholesale costs per patient per year of treatment � has led to widespread debate about the appropriate use and financing of these medications.

The results are based upon a comprehensive computer model of HIV disease developed by the team of researchers, led by Kenneth A. Freedberg, MD, MSc of the MGH 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, and thus forecast the long-term effects of the disease. Outcomes are represented in terms of patients� average life expectancy, AIDS-related disease occurrences and total medical costs.

For patients with advanced AIDS � similar to those in national AIDS Clinical Trials Group studies conducted at MGH and other centers � 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 year of life saved, a measure of the costs to improve and extend life. This value is similar to the treatment of high blood pressure, and more cost-effective than treating high cholesterol or breast cancer in non-AIDS patients.

In this recent study, Freedberg and colleagues demonstrate that the high cost of treatment is more than balanced by the dramatic benefits for those living with HIV. "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," states Freedberg, the study�s principle investigator.

"The results of our analysis do not mean that HIV therapy will save money in the long run," adds Freedberg. "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."

Co-authors of the study are Elena Losina, PhD, April Kimmel, and Hong Zhang of the MGH Division of General Internal Medicine and Partners AIDS Research Center; Milton C. Weinstein, PhD, George R. Seage, DSc, MPH, and Sue J. Goldie, MD, MPH of the Harvard School of Public Health; Calvin J. Cohen of the Community Research Initiative of New England; and Donald E. Craven of the Boston University School of Medicine. The study was supported by the National Institute of Allergy and Infectious Diseases and the Centers for Disease Control and Prevention.

Established in 1811, Massachusetts General Hospital is the original and largest teaching hospital of Harvard Medical School. MGH conducts the largest hospital-based research program in the United States, with an annual research budget of almost $250 million and major research centers in AIDS, the neurosciences, cardiovascular research, cancer, cutaneous biology, transplantation biology and photomedicine. In 1994, MGH joined with Brigham and Women�s Hospital to form Partners Healthcare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups, and nonacute and home health services.