- 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
- 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
- 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
- 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."