Pharmacoeconomics

Patrick G. Clay, PharmD Director, Dybedal Center for Clinical Research Associate Professor of Medicine, Department of Basic and Clinical Sciences Kansas City University of Medicine and Biosciences 1750 Independence Avenue Kansas City, Missouri 64106-1453

Pharmacoeconomics Legal and Financial Issues of HIV Care Policy Brief: Trends in U.S. Spending on HIV/AIDS[PDF] Policy Brief: U.S. Spending on Global HIV/AIDS[PDF] Policy Brief: Global Spending on HIV/AIDS in Resource-Poor Settings[PDF] Past Contributions

The pharmacoeconomic page is here to act as a portal to information regarding the cost-effectiveness and economic aspects of therapy and disease on the US and the world. As the turnover of knowledge becomes more rapid in HIV Pharmacotherapy, many of the assumptions made in earlier evaluations do not hold true. As such, the foundation for earlier articles should be closely examined as persons with HIV are living longer and with more improved quality of life. As such, the proportions used for increase of lifespan and degree of quality warrant close inspection in many articles previously published to ensure they are still applicable today.

As publications come forth, these will be added to the abstracts and references section. Many individuals in the government, academia and private sector are completing timely and relevant studies on the economic aspects of various components of HIV and AIDS in the US and the world. These persons publish their material after it is thoroughly reviewed and as such, abstracts from conferences or community organizations will not be referenced here. This information will be reviewed at least quarterly and new information will be forwarded to the webmaster for inclusion as appropriate. As material is needing to be replaced, that will be done as well.

Pharmacoeconomics 1996 Jul;10(1):72-8 Related Articles, Books Pharmacoeconomics of Pneumocystis carinii pneumonia in HIV-infected and HIV-noninfected patients. Nicolau DP, Ross JW, Quintiliani R, Nightingale CH. Department of Pharmacy, Hartford Hospital, Connecticut, USA.

Despite the proven effectiveness of Pneumocystis carinii pneumonia (PCP) prophylaxis in both HIV-infected and HIV-noninfected patients, PCP remains an important cause of serious pulmonary infection. Because PCP is a frequent event requiring inpatient admission at our institution, we conducted a study to define the pharmacoeconomics of this infection and the incidence of adverse events associated with anti-PCP therapy. In a retrospective review, 133 patients (101 HIV-positive, 32 HIV-negative) with documented PCP were identified. Significant differences in age, initial arterial oxygen tension (paO2), intensive care unit admission and mortality were evident between HIV-infected and non-HIV-infected patients; however, there were no differences in the duration of hospitalisation or the duration of anti-PCP therapy. The incidence of biochemical abnormalities was similar between the groups. Leucopenia occurred at an incidence of 52 and 31%, while thrombocytopenia occurred at a rate of 7 and 44%, in HIV-positive and HIV-negative patients, respectively. Drug toxicity or treatment failure necessitated a change of therapy in 43% of HIV-positive and 59% of HIV-negative patients. PCP treatment cost, pharmacy cost, hospital cost and net loss (i.e. the difference between hospital cost and reimbursement) were all significantly greater in HIV-negative than in HIV-positive patients. The duration of anti-PCP therapy and the hospital cost for cotrimoxazole (trimethoprim-sulfamethoxazole)- and pentamidine-treated patients were similar, although the treatment cost and pharmacy cost were statistically different in favour of cotrimoxazole. Overall, cotrimoxazole is an inexpensive treatment option. However, the high incidence of adverse events attributed to this agent often necessitates a change to a more costly therapy.

International AIDS Economic Network. This provides updates on primarily vaccine related economic issues. Contains links to sites that focus on various cost-analysis reports. http://www.iaen.org

World Bank website providing their perspective on the AIDS medicines. They have numerous links to charts and graphs depicting the spread of AIDS and relate how the World Bank has provided funding for many initiatives. http://www.worldbank.org

This World Bank Site is their general information site. This will provide information regarding the funding World Bank is providing (to whom, for what, how much, etc). http://www.worldbank.org/aids-econ/

UNAIDS site provides statistical information about the spread of AIDS and its related issues. http://www.unaids.org

Kaiser Foundation website for HIV/AIDS. This site will provide timely and relevant information about how AIDS, HIV and its co-morbid diseases, STDs, prevention and vaccine efforts in the United States are being viewed. Able to find consumer and non-medical personnel's opinion on many topics, including the priorities of HIV in the US budget. Non-governmental funding and often times at odds with whatever political party is in power. http://www.kff.org/hivaids/

CDC AID website. Numerous statistics and breakdowns of AIDS in the US. http://www.cdc.gov/hiv/pubs/facts.htm

Bozzette, Joyce, McCaffrey, et al. Expenditures for the Care of HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy. [Record Supplied By Publisher] N Engl J Med (United States), Mar 15 2001, 344(11) p817-823. [PubMed]

Freedberg KA, Losina E, Weinstein MC, et al. The cost effectiveness of combination antiretroviral therapy for HIV disease. N Engl J Med (United States), Mar 15 2001, 344(11) p824-31. [PubMed]

Weinstein Milton C., Goldie Sue J., Losina Elena, et al. Use of Genotypic Resistance Testing To Guide HIV Therapy: Clinical Impact and Cost-Effectiveness. [Record Supplied By Publisher] Ann Intern Med (United States), Mar 20 2001, 134(6) p440-450. [PubMed]

Cunningham WE, Markson LE, Andersen RM, et al. Prevalence and predictors of highly active antiretroviral therapy use in patients with HIV infection in the united states. HCSUS Consortium. HIV Cost and Services Utilization. J Acquir Immune Defic Syndr (United States), Oct 1 2000, 25(2) p115-23. [PubMed]

Ostrop NJ, Gill MJ. The costs of antiretroviral drug wastage [letter]. AIDS (England), Mar 31 2000, 14(5) p616-7.

Andersen R, Bozzette S, Shapiro M, et al. Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS Consortium. HIV Cost and Services Utilization Study. Health Serv Res (United States), Jun 2000, 35(2) p389-416. [PubMed]

Mocroft A, Gill MJ, Davidson W, et al. Are there gender differences in starting protease inhibitors, HAART, and disease progression despite equal access to care? J Acquir Immune Defic Syndr (United States), Aug 15 2000, 24(5) p475-82. [PubMed]