The pharmacoeconomics of HIV disease

Human immunodeficiency virus (HIV) infection is a major public health problem in all parts of the world. For the United States, federal spending on HIV disease for 1982 to 1989 was $US5.5 billion. Projections indicate that AIDS spending may reach 1.6% of total health expenditures in 1992, while the indirect costs of HIV infection may be 5 times as great as the direct costs. In the developing world, the cost per person with HIV infection may be 0.8- to 9-fold greater than the per capita gross national product (GNP). Pharmacoeconomic analysis has been used to assess 2 important therapeutic options in caring for HIV patients: zidovudine therapy for asymptomatic illness, and prophylaxis for Pneumocystis carinii pneumonia (PCP). The cost-effectiveness ratio for zidovudine therapy, $US6553 to $US70 526 per year of life saved, compares favourably with ratios for other medical therapies. Prophylaxis against Pneumocystis carinii pneumonia has been shown to be most efficient using oral dapsone or cotrimoxazole (trimethoprim-sulfamethoxazole). Pharmacological therapy for HIV is costly, however, and may limit the access to new therapies for patients in the developing world. Concurrent economic assessment of therapies during phase III trials may serve as an essential part of the research that will advance international efforts to combat this disease.