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Treatment is found to be cost-effective




 

THIS WEEK, a study in the Journal of the American Medical Association concludes that the cost of AIDS care, although expensive, falls within the price range of widely accepted treatments for other diseases.

The most cost-effective combination of antiviral and antibiotic medicines to treat HIV costs between $29,000 and $40,000 to extend life expectancy one year, according to the study by researcher Dr. Kenneth Freedberg and colleagues at Boston Medical Center in the Jan. 14 edition of the medical journal.

This compares with $15,000 for hypertensive drug therapy, $22,000 for breast cancer treatment, $26,000 for coronary artery bypass graft surgery, $46,000 for renal dialysis and $154,000 for one form of high cholesterol treatment. "The most highly recommended and effective treatments are worth their costs," wrote Dr. David N. Rose of Long Island Jewish Medical Center in New Hyde Park, N.Y., in an accompanying editorial. "Providing timely access to these cost-effective AIDS drugs to all patients with HIV infection can add quality years to their lives."

The study focused most closely on the use of antibiotics to prevent AIDS-related infections like pneumonia, toxoplasmosis and Mycobacterium avium complex. Freedberg's team developed a computer-based model to compare the clinical impact, cost and cost-effectiveness of drug therapies to prevent these infections.

They compared different antibiotics and found that:

*Trimethoprim-sulfamethoxazole to prevent pneumonia and toxoplasmosis cost $16,000 per year of life saved.

*Azithromycin to prevent Mycobacterium cost $35,000 per year saved.

*Fluconazole to prevent fungal infections cost $100,000 per year saved.

*Ganciclovir to prevent cytomegalovirus cost $314,000 per year saved.

When the new triple combination anti-viral drugs were added to the regimen, cost-effectiveness remained, the researchers found. Although the data were too speculative to provide firm conclusions, Freedberg found that adding these very expensive drugs boosted life expectancy between 43 and 47 months, for a total lifetime cost of between $72,300 and $79,100.

Vaccine news

Officials at a Bay Area-based AIDS vaccine company are seeking approval from the U.S. Food and Drug Administration to begin human trials of their vaccine later this year.

The $20 million study by Vaxgen Inc. of South San Francisco would involve 7,500 healthy volunteers and take about three years to complete. About 5,000 volunteers would be Americans; the other 2,500 would be Thai. Half of the participants would get the vaccine, and half would get an inactive placebo.

The vaccine, based on HIV's gp120 protein, reintroduces a strategy that several years ago was widely thought to have failed. The approach has been improved by incorporating two strains of HIV rather than just one, according to the company.

Thus far, all but a handful of the 1,000 people who have been injected with the vaccine show a strong immune response, said Vaxgen's president, Dr. Donald Francis.

Still unknown is whether this immune response will actually prevent infection.

News briefs

*The 1998-99 state budget proposal unveiled by Gov. Wilson provides an increase of $35.9 million to expand the AIDS Drug Assistance Program, which provides HIV drugs to people who otherwise would be unable to afford them. Events

*UC-San Francisco researchers are holding a town meeting to discuss the risk of anal cancer in HIV-infected men with a history of receptive anal intercourse. The cancer, although deadly, can be identified and treated with regular Pap smears. The results of a new study on the cancer will be disclosed at a meeting Jan. 28 from 7:30-9 p.m. at the Metropolitan Community Church, 150 Eureka St. Call (415) 476-2909.

*A free, interactive telephone conference, called "Report From the Fifth Conference on Retroviruses and Opportunistic Infections" will be held at noon Feb. 5, featuring Dr. Stephen Follansbee of Davies Medical Center and others. Advance registration is required. Call 1-800-707-BETA to register. The conference will be held Feb. 1-5 in Chicago.

*The annual AIDS Theater Festival will be held at the San Francisco Civic Auditorium March 24-27. It will feature HIV-related plays, performance art, music and dance. Call (415) 554-8436.

* "The Changes Project" is recruiting participants. The UC-San Francisco study is designed to find the best way to help gay men master the new challenges of living with HIV. The study, which pays volunteers $90 to $120, seeks gay, HIV-infected men who are experiencing stress, medical side effects, financial worries or other concerns. Its findings will be used to develop health care guidelines for infected men, their doctors and communities. Call (415) 597-9169.

The toll

Jon Fryman, 46, an accomplished Los Angeles-based artist whose artwork appeared in the feature films "Red Ribbon Blues" and "Touch Me" . . . William Garcia, 29, a Costa Rican AIDS activist who sued his country's government after he was refused payment assistance for costly HIV medications; he won the legal battle but died three weeks later . . . Lawyer Jerry Roemer, 32. He gained national attention as a model of the "Lazarus" effect of protease inhibitors, described in the New York Times after his boss, Attorney General Janet Reno, declared him an inspiration after he became well enough to return to work at the Department of Justice, in Washington, D.C. . . . Harriet Browne, 67, mother, grandmother, church member, and tap dancer extraordinaire who shared bills with Cab Calloway, Billie Holiday and Gregory Hines in Carnegie Hall and elsewhere in New York City.

. . . . . .Date . . . . . .reported. . Cases. . Deaths S.F.. . . .1/1 . . . . 24,881. 16,974 Calif.. . .1/1 . . . .104,638 . 66,263 U.S.. . . .1/1 . . . .612,078 .379,258 WHO(rprtd) 1/1 . . .8,400,000 6,400,000

Figures are cumulative since June 1981. Government officials now compile and release statistics quarterly, not monthly. To contribute to AIDSweek, call (415) 777-7867.

AIDSweek columns are available on the Internet at www.examiner.com / aidsweek / aidsweek.html Figures are cumulative since June 1981. Government officials now compile and release statistics quarterly, not monthly.

To contribute to AIDSweek, call (415) 777-7867. AIDSweek columns are available on the Internet at www.examiner.com / aidsweek / aidsweek.html



 


Copyright © 1998 -The Bangkok Pos, Publisher. All rights reserved to San Francisco Examiner. All rights reserved. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the San Francisco Examiner, Permissions Desk, 110 Fifth Street, P.O. Box 7260, San Franciso, CA 94120.San Francisco Examiner

Information in this article was accurate in January 14, 1998. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.