Are Protease Inhibitors Cost Effective?
John G. Bartlett, M.D.
Protease inhibitors have revolutionized therapeutic strategies in managing HIV
infection. Many feel, however, that their high cost threatens to bankrupt the
system. The new regimens that are now widely advocated normally cost between
$9,000-12,000 per year. The potential impact of this price tag on provider
organizations is awesome: the projected cost for AIDS Drug Assistance Programs
(ADAP) is $436 million per year. These projections introduce the dual challenge
of finding sources of funds and justifying this expense at this time of cost
reduction throughout the system.
Estimates of morbidity and mortality with AZT monotherapy are based on our
experience at Hopkins as previously reported [Chaisson RE, Keruly JC, Moore, RD.
N Engl J Med 1995; 333:751-6]. The benefit of therapy is estimated from the VA
study using viral burden correlates with CD4 slope [O'Brien WA, Hartigan PM,
Martin D, et al. N Engl J Med 1996; 334: 426-31] .
Table 1: Cost Effectiveness of Protease Inhibitor Regimens
|Triple therapy for HIV (AZT + 3TC + indinavir)||$10,000-18,000|
|Screening mammography, age 40-79 yrs.||$30,000|
|Prostate specific antigen screen, 50 yr. old men||$113,000|
|Coronary bypass surgery, 50 yr. old men with|
triple vessel disease
Adapted from: PharmacoEconomics 1996 Aug: 10(2): 109-113
The conclusion from this analysis is that the cost of the new regimens advocated for HIV infected persons appears to be cost effective compared to other commonly accepted strategies in medical care.
Figure 1: Model of the cumulative direct costs of medical care in patients with HIV infection receiving antiretroviral therapy. Costs are based on an analysis of the direct healthcare costs for patients with HIV infection in the U.S. [Hellinger FJ. JAMA 1993; 270: 474-8]. Reprinted, with permission, from PharmacoEconomics 1996 Aug: 10 (2): 109-113.