Speech given by Mr Paul Gross
Hospitals Contribution Fund and Director of Health Group Strategies Pty. Ltd.
Conference Paper: AIDS – Have we got it Right?
A conference organised by The Australian Doctors Fund Ltd.
Hosted by Professor Fred Hollows & ADF Chairman Dr. Bruce Shepherd
Sheraton Sydney Airport Hilton
May 14th and 15th, 1992
Recent Estimates of Costs, USA by Service Component – % of total
| COMPONENT | CALIFORNIA | NEW YORK |
| Inpatient Care | 72.8 | 78.0 |
| Outpatient Care | 8.3 | 9.4 |
| Long-term Care | 1.3 | 0.7 |
| Home Health Care | 4.2 | 0.8 |
| AZT, aerosol pentamidine, other drugs | 13.3 | 11.0 |
Estimated Prevalence of AIDS and HIV ASIA, CIRCA 1991
| — | AIDS CASES | HIV CASES | MAIN MODE OF TRANSMISSION |
| Cambodia | 0 | 2 | Not Available |
| China | 6 | 518 | Intravenous Drugs |
| Hong Kong | 58 | 193 | Homosexual/Bisexual |
| India | 4,848 | 400,000 – one million* | Heterosexual |
| Indonesia | 30 | 26 | Not Available |
| Japan | 415 | 1,898 | Contaminated Transfusions |
| Laos | 0 | 7 | Not Available |
| Malaysia | 34 | 2,189 | Intravenous Drugs |
| Phillipines | 56 | 277 | Heterosexual |
| South Korea | 8 | 154 | Heterosexual |
| Singapore | 30 | 50 | Homosexual/Bisexual |
| Taiwan | 40 | 240 | Heterosexual |
| Thailand | 190 | 200,000 – 500,000* | Heterosexual |
| Vietnam | 0 | 1 | Not Available |
| * Estimated AIDS/HIV cases from surveillance data. Other figures are actual case reported. | |||
| Source World Health Department and other statistics supplied by various government and nongoverned sources. | |||
Projecting Treatment Costs Persons with AIDS
|
Annual Costs, Outpatient Care, US Studies HIV Infected persons without AIDS
| — | Arno et al. a | — | — | — | |
| — | Pretreatment | Treatment | Hawaii b | Michigan c Medicaid |
New Jerseyd TAP |
| Drugs | $593 | $385 | |||
| AZT | $6,032 | $2,700 | |||
| Aerosol Pentamidine | $2,000 | $3,000 | |||
| Anti-fungals | $500 | ||||
| Acyclovir | $1,100 | ||||
| Office and clinic visits | $426 | $576 | $500 | $6,708 | $900 |
| Laboratory and X-ray | $368 | $879 | $1,600 | (also includes laboratory and X-ray charges) |
$540 |
| Counselling and other costs | $60 | $150 | |||
| Total | $854 | $9,637 | $9,400 | $7,301 | $1,825 |
| a Arno, P.S D. Shenson, N Siegel, P. Franks, and P. Lee, 1989. Economic and Policy Implications of Early Intervention in HIV Disease, JAMA 262 (11): 1493-98. | |||||
| b Data provided by Nancy Kern, the Governor’s Committee on AIDS, Hawaii State Dept. of Health, Honolulu, Hawaii, June 15th 1990. | |||||
| c Data provided by David Solomon, Michigan State University, October 31st, 1990. | |||||
| d The figures here are estimates and were provided by Steven Young, director, Division of Care and Treatment, New Jersey State Dept. of Health, October 30th, 1990, about enrollees in New Jersey’s Treatment Assessment Program. | |||||
Cost Effectiveness Analysis in Health Care Data Needed
| CEA: Measures Costs and Effectiveness of Two Interventions
Costs – Costs of treatment Effectiveness COST-EFFECTIVENESS – |
Cost effectiveness of medical interventions
| Strategy | US$/year of life saved |
| Smoking cessation counselling | 6,463 |
| Early zidovudine (continuous benefit) | 6,553 |
| Oat bran for high cholesterol | 21,189 |
| Renal dialysis | 42,249 |
| Early zidovudine (one-time benefit) | 70,526 |
| Colestipol | 85,519 |
| Coronary artery bypass grafting | 113,087 |
| Cholestyramine | 141,600 |
| Screening mammogram (women under 50) | 167,850 |