March 23, 2001

Three-drug combination therapy for AIDS, in spite of its great expense, is a cost-effective use of resources, according to a report by MGH researchers in the March 15 issue of the New England Journal of Medicine.

Three-drug antiretroviral therapies, or "HIV drug cocktails," have been proven highly effective in suppressing the HIV virus and preventing disease progression. However, the enormous price of these drugs — averaging about $12,000 in wholesale costs per patient per year of treatment — has led to widespread debate about their use and financing.

The study's results are based upon a comprehensive computer model of HIV disease developed by the team of researchers, who are led by Kenneth A. Freedberg, MD, MSc, of the MGH Division of General Internal Medicine and the Partners AIDS Research Center. The model incorporates the most up-to-date data on HIV disease and therapy, and simulates the disease progression of large populations of HIV-infected patients, therefore forecasting the long-term effects of the disease. Outcomes are represented in terms of patients' average life expectancy, AIDS-related disease occurrences and total medical costs.

According to the study, combination therapy was associated with a near doubling in life expectancy for patients with advanced AIDS, from 1.53 years to 2.91 years when adjusted for quality of life, and with an increase in total medical costs from $45,000 to $77,000. This leads to a figure of $23,000 per quality-adjusted year of life saved, a measure of the costs to improve and extend life.

This value is similar to that involved in the treatment of high blood pressure, and it is more cost-effective than treating high cholesterol or breast cancer in non-AIDS patients.

In this recent study, Freedberg and his colleagues demonstrate that the high cost of treatment is more than balanced by the dramatic benefits for those living with HIV. "Three-drug combination therapy can significantly increase life expectancy, decrease AIDS-related disease incidence, and quantifiably improve HIV patients' overall quality of life — all for a very reasonable cost to society," states Freedberg.

The study is co-authored by Elena Losina, PhD, April Kimmel and Hong Zhang of the MGH Division of General Internal Medicine and Partners AIDS Research Center; and colleagues from the Harvard School of Public Health, Community Research Initiative of New England and the Boston University School of Medicine.