GENEVA, Switzerland--Thousands of U.S. AIDS deaths and late-stage cases of the disease could be averted by expanding federal Medicaid coverage of HIV drugs, according to a new study by University of California San Francisco AIDS policy researchers.
"Combination therapy using antiretroviral medications is now available and for the first time offers real hope for controlling HIV infection, but not everyone has access to these drugs," said principal investigator James G. Kahn, MD, MPH, an associate professor of health policy and epidemiology with the UCSF AIDS Research Institute.
"Our analysis was directed at finding an affordable solution to this dilemma, while assessing the health and federal cost implications," he said. Research findings were reported here today (Wednesday, July 1) at the 12th World AIDS Conference.
In the UCSF study, researchers propose expanding the Medicaid system to cover HIV care and related drug therapy for patients who meet two conditions: lack of insurance for HIV antiretroviral drugs and an annual income below $10,000, which is 125 percent of the national poverty level for a single person. The UCSF team is the first to report on this type of benefit expansion.
Study findings show the expansion would result in 9,600 more years of life for persons with HIV disease over five-years. There would be 4,200 fewer deaths with this program, and 11,400 fewer individuals with early-stage HIV infection would progress to late-stage AIDS because of proper drug treatment.
The UCSF analysis compared projected outcomes over a five-year period with and without the expansion. An estimated 38,000 persons would be enrolled in the expansion group. Of these, two-thirds were projected to be HIV positive and in the early stages of infection and one-third to have AIDS.
The analysis took into account the savings that would occur in other federal and income support programs, such as the AIDS Drug Assistance Program that provides medications to persons who do not have access through other means.
"An 11 percent reduction in HIV drug prices to the Medicaid system would generate $110 million per year--enough to make this expansion program no cost to the federal government," Kahn said. "The proposed expansion would increase net drug sales by nearly $200 million, largely because the increase in drug sales volume more than offsets the price reduction."
The UCSF study incorporated several clinical and fiscal calculations, including estimates of the number of people living with HIV by disease stage; likelihood of qualifying and enrolling in the expansion; insurance status, income, and access to antiretroviral therapy of individuals; effectiveness of therapy in reducing HIV progression; and cost of HIV medications and care. Brian Haile, research associate, UCSF Institute for Health Policy Studies, was a study co-investigator.
The research was supported by a grant from the Henry J. Kaiser Family Foundation, Menlo Park, Calif.
The UCSF ARI is an institute without walls that encompasses all UCSF AIDS programs under a single umbrella. Thomas J. Coates, PhD, is director. The UCSF ARI includes a dozen research institutes, a wide range of clinical, behavioral science, and policy programs, and close to 1,000 investigators.