AIDS Conference 1992 Session 18 – Mr Paul Gross

May 18, 1992AIDS Conference

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

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

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

  • Cost per Calendar Year: Two Components
    -Inpatient Costs
    Average LOS, Charge/bed-day, # admissions
    – Outpatient Costs
    charge/outpatient visit, # outpatient visits
    plus costs of long term care
    plus costs of home health care
    plus costs of drugs
  • Cost per lifetime
    Calendar year cost
    average survival time (years)/average # months alive during years of survival


Annual Costs, Outpatient Care, US Studies HIV Infected persons without AIDS

Arno et al. a
Pretreatment Treatment Hawaii b Michigan c
New Jerseyd
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)
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
plus Costs of treating any side effects
minus Costs of future treatments averted

– saving in life-years
or savings in quality-adjusted life years.

Cost per life year saved
or Cost per quality adjusted life year saved.


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