Two In Three HIV-Infected
In US Are Not Treated
Almost two-thirds of HIV-infected Americans do not receive regular medical treatment, a national survey shows, though caring for AIDS patients is only about one-third as expensive as has been previously estimated. The data explode the widespread belief that care for the HIV infected is extraordinarily costly. -- Dr. Samuel A Bozzette, Rand Corporation. The survey, perhaps the most comprehensive to date, found that up to 66 percent of people with HIV infection are not getting regular care. And even fewer are receiving the powerful drug cocktails incorporating protease inhibitors that are credited with bringing many patients back to life, said study co-director Dr. Samuel A. Bozzette.
Many of those not getting care were unaware they were infected, the survey showed.
Treatment generally runs about $22,000 per year, the survey found, compared with previous estimates of upwards of $60,000. "The data explode the widespread belief that care for the HIV infected is extraordinarily costly," Bozzette said in a statement. "Although it is a large and growing burden on the public sector, HIV care is less expensive than care for many other serious diseases."
Overall, HIV disease costs the nation $6.7 billion annually, or less than 1 percent of all U.S. medical expenditures on patients, the survey showed. "The real crisis in paying for HIV care is not cost, but rather how to finance it," said Bozzette, a researcher at RAND, the Santa Monica, Calif., think tank.
According to the Centers for Disease Control and Prevention, between 650,000 and 900,000 Americans are infected with HIV.
For the new study, published in Thursday's New England Journal of Medicine, the researchers interviewed 2,864 people with HIV infection who were receiving care from 145 providers in 28 metropolitan areas and 51 providers in rural areas.
Among the findings:
Sixteen percent of people being treated for HIV were taking one of the newer AIDS drugs at the start of 1996. By the end of that year, the number had shot up to 55 percent and doctors believe it has risen further still since then. "The pattern of use of protease inhibitors and non-nucleoside reverse transcriptase inhibitors...recently developed drugs that are highly effective in suppressing HIV infection...changed rapidly in 1996," Bozzette said. "It is encouraging to see that they diffused quickly."
Twenty percent of people with HIV have no health insurance; 29 percent are covered by Medicaid, the federal program for the poor; and 19 percent had their treatment covered by Medicare.
Only half of all American adults infected with the AIDS virus saw their doctor at least once every six months.
An encouraging 85 percent of those with full-blown AIDS were getting regular care, with most of them seeing AIDS specialists, Bozzette said.
The demographic and socioeconomic characteristics of the population under care for HIV infection are strikingly different from those of the U.S. population as a whole. Americans under care for HIV are disproportionately male, black, unemployed, poor and lacking private health insurance.
Thirty percent of patients received care at major teaching hospitals; the balance received their care from office-based physicians and community hospitals and clinics.
One-third made at least one visit to an emergency room and 20 percent were hospitalized every six months. Their stays accounted for about 1 percent of all hospital days in the United States.
Hospital care accounted for 43 percent of patients, direct medical care costs, pharmaceuticals for 39 percent, emergency department care for 2 percent, and other outpatient care and associated costs for 15 percent.
Seventy-seven percent of HIV-infected patients were men and 89 percent were less than 50 years old.
Treatment for those with HIV is likely to stay fragmented unless the government takes steps to change access to care, said Dr. Robert Steinbrook, one of the journal's editors, in an editorial accompanying the report. One idea, he said, is for "the government [to] do what large private purchasers of health care do - that is, negotiate with pharmaceutical manufacturers for additional price reductions and discounts for medications to treat HIV."