Clinton Foundation negotiates $140/Year HIV treatment, but U.S. won't buy

The Clinton Foundation, World Bank, UNICEF, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria announced that they could negotiate prices as low as $140 per year for triple-combination antiretroviral therapy. But the Bush Administration is refusing to buy generic medicines for its major HIV treatment program.

Cost-effectiveness of postexposure prophylaxis after sexual or injection-drug exposure to human immunodeficiency virus

BACKGROUND

The cost-effectiveness of interventions that provide human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) to individuals after sexual or injection-drug use exposures depends on the distribution of exposure routes, prevalence of infection among source partners, adherence to PEP regimens, medical care costs, and prevailing epidemiologic contexts, among other factors.

OBJECTIVE

To determine the cost-effectiveness of a comprehensive program to prevent HIV infection after sexual or injection-drug use exposure for 401 persons seeking PEP in an urban community.

METHODS

We conducted a retrospective cost analysis to evaluate the cost of the PEP intervention, then combined this information with model-based effectiveness estimates to determine the PEP program's "cost-utility ratio," which is the ratio of net program costs to the total number of quality-adjusted life-years (QALYs) saved by the program.

RESULTS

The average cost of the PEP regimen was $1222, and the total cost of the program was $450 970. The PEP program prevented an estimated 1.26 HIV infections, saved 11.74 QALYs, and averted $281 323 in future HIV-related medical care costs. The overall cost-utility ratio was $14 449 per QALY saved. When analysis was restricted to men reporting receptive anal intercourse, the savings in averted HIV-related medical care costs exceeded the cost of the program. The results were generally robust to changes in key parameter values but were sensitive to assumptions about the HIV transmission probability for receptive anal intercourse.

CONCLUSIONS

For this study population, HIV PEP was cost-effective by conventional standards and cost-saving for persons seeking PEP after male-male receptive anal intercourse.

Costs associated with combination antiretroviral therapy in HIV-infected patients

As more effective HIV therapies have become available, resource constraints and cost-effectiveness have increasingly been at the centre of the debate on HIV care. Economic analysis is an important methodological approach to the understanding and establishment of priorities for health interventions designed to combat HIV in both high-income and low-income countries. In this paper, I briefly discuss different types of clinical economic analysis, and then consider the cost, affordability and cost-effectiveness of combination antiretroviral therapy in HIV patients in high-income and low-income countries. In high-income countries, HIV disease has become an expensive treatable chronic disease, with annual expenditures per patient of about US$ 20 000. Cost-effectiveness analyses show that antiretroviral therapeutic regimens offer good value for the resources spent compared to many other accepted health care interventions. In low-income countries, major programmes of combination antiretroviral therapy distribution are being planned and becoming operational as drug prices plummet and resources increase. More refined cost-effectiveness analyses are needed to evaluate available HIV/AIDS prevention, treatment, and care, and to identify the interventions that provide the best value for money.

Justice and HIV care in Africa--antiretrovirals in perspective

The immense burden of HIV disease in sub-Saharan Africa has focused international interest on HIV care, especially on the lack of access to antiretroviral therapy (ART). Difficulties in implementing ART in Africa include drug costs, adequate long-term funding sources, assurance of drug quality, and rapid development of the human resources and healthcare infrastructure needed to deliver ART. Important questions requiring study are the minimum level of laboratory monitoring and clinical support consistent with good treatment outcomes, the impact of antiretroviral drug resistance on treated individuals and communities, and the effect of ART on transmission at a community level. There are some concerns and risks. First, a focus on treatment could compromise the commitment of individuals to risk-reduction, and of governments to prevention. Second, health equity could be reduced, by diverting scarce public funds from basic care for the poorest, to costly disease-suppressive care for a small and probably elite group. In conclusion, while prevention must be the first priority, care is also essential. The vast prevailing economic inequity between the world's rich and poor is the fundamental determinant of inequities in health and healthcare, including care for HIV. The global community of healthcare workers must focus its substantial influence on changing political and economic policies that foster injustice and AIDS.

New data from the CDC confirm HIV is on the rise

The CDC has unveiled data showing that new HIV diagnoses have increased 5% between 1999 and 2002, and says the statistics likely reflect an increase in HIV cases and not simply increased HIV testing. The recent report offers the strongest evidence to date that the nation's prevention efforts are beginning to fail.

Cost effectiveness analysis of routine use of genotypic antiretroviral resistance testing after failure of antiretroviral treatment for HIV

OBJECTIVES

Single use of genotypic antiretroviral resistance testing (GART) after first failure of highly active antiretroviral therapy (HAART) was reported to be cost effective; its use prior HAART initiation is unknown. Guidelines recommend GART after each treatment failure. We assessed the cost effectiveness of GART used routinely after first and subsequent treatment failures. Furthermore, we determined the minimum effectiveness required for GART prior to the first HAART to be as cost effective as after treatment failure.

DESIGN AND METHODS

We developed a decision-analytic Markov model to estimate lifetime clinical and economic outcomes in a cohort of HIV patients starting HAART. Rates of treatment failure, estimates of GART effectiveness and data on disease progression were derived from published trials and observational studies. A cost effectiveness analysis was performed from the perspective of the healthcare system using cost data from a Central European healthcare setting. Deterministic and probabilistic sensitivity analyses using Monte Carlo technique were performed.

RESULTS

GART after treatment failures increased life expectancy by 9 months and undiscounted life-time costs per case by 16,406 euros. The discounted incremental cost effectiveness ratio was 22,510 euros per life-year gained (euros/LY). Best- and worst-case scenarios yielded 16,512 euros/LY and 42,900 euros/LY, respectively. GART prior to the initiation of HAART would be equally cost effective if it could reduce the probability of first HAART failure by at least 36%.

CONCLUSION

Routine use of GART after treatment failures is cost effective. GART prior to the first HAART would be equally cost effective if it could lower the probability of first HAART failure by approximately a third.

What are STIs and what are the goals of STIs?

STIs (Structured Treatment Interruptions) involve going off anti-HIV therapy for periods of time in a structured and strategic fashion, typically guided by increased lab and health monitoring. In all, more than two dozen studies of STIs of varying types have been conducted since 1998. It is important to note that interpreting the results of STI research can be challenging. Some of the assumptions about HIV disease that led researchers to investigate treatment interruptions in the first place have yet to be proven conclusively. At least some of the research on STIs, however, has been promising and other research has made clear those areas where interrupting therapy is neither safe nor effective.