A treatment that's being billed as a big breakthrough in AIDS is prompting a very uncomfortable question: How much are we willing to pay to prevent people from becoming infected with HIV? Scientists at San Francisco's Gladstone Institutes announced that gay men and some transgendered women who took a daily pill called Truvada were 73 percent less likely to become infected with the virus. The study was published in the New England Journal of Medicine today.
"This is a very exciting, dynamic time in HIV prevention research," Alan Bernstein, head of the Global HIV Vaccine Enterprise, a non-profit, tells USA Today. "It couldn't come at a better time. There's clearly a growing realization that we're not going to be able to treat our way out of this epidemic."
But that promise comes at a cost.
Truvada, made by Gilead Sciences of Forest City, California, is already sold to treat HIV infections at a cost of about $36 a day. That can add up to $13,000 a year, although there are cheaper, generic versions available overseas.
David Paltiel of Yale University tells USA Today that his research shows that Truvada could be as cost-effective a prevention method as those used to combat heart disease diabetes and cancer.
But there area a lot of calculations to consider.
Four years ago, the cost of caring for an AIDS patient in the U.S. was estimated at about $25,000 a year — or $600,000 over the average life span of 24 years. That's up significantly from estimates in the 1990s, when there were fewer drugs and shorter life spans.
But according to the Centers for Disease Control and Prevention, the HIV epidemic is still growing among gay and bisexual men. Gay and bisexual men are 44 times more likely to get HIV than other men, CDC statistics show. They now account for more than half of roughly 60,000 new HIV infections that occur nationwide each year.
So targeting the prevention pill might be one way to make it cost effective.
Cost-effectiveness analyses should help determine whether insurers and government programs should help pay, says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Another crucial element to be considered is compliance. If people don't take the drug, it's not going to work.
Among men who took their pills at least half the time in the study, the risk of infection fell by 50 percent. For those who took pills every day about 90 percent of the time, the risk fell 73 percent the study says.
NPR's Richard Knox will have more on this story tonight on All Things Considered.
