Cost Implications of AIDS Aid

Congress is moving quickly to approve an additional $20 million to fund AZT for those with the human immunodeficiency virus (HIV) that causes AIDS. The action is appropriate to a need that can only increase, and increase dramatically. Research by the National Institutes of Health has now demonstrated that AZT is effective in prolonging the lives of those with the infection before they show symptoms of AIDS, as well as the lives of those with full-fledged symptoms.

The cost implications of the discovery are enormous, however. The nation was hard-pressed to meet the cost of AZT for AIDS patients. California, the only state with a substantial AZT program funded from state revenues, is a case in point. The California program is now providing AZT to about 1,400 persons a month. The state’s AZT budget is $2.5 million this year. But the total infected population in California may be as high as 250,000 persons, and even if only 40% of that group qualified for state-supported treatment, and even calculating the treatment at lower dosages, that would indicate a cost of $300 million a year.

At the federal level, there are no precise cost estimates of extending AZT to asymptomatic persons with HIV infection, but experts have spoken of an annual cost of $2.5 billion to cover basic treatments, including aerosol pentamidine, AZT and the immune system tests required to monitor the treatment program for the infected population. The $20-million increase in federal funding approved by the Senate Appropriations Committee only brings the level of federal funding to $30 million, the level where it was in 1987.

Formal approval of the use of AZT for asymptomatic HIV-infected persons by the Food and Drug Administration is required. When that formality is completed, there will be greatly increased demand for subsidized treatment as well as for coverage by private insurance plans that include prescription drugs. But it is by no means clear where the vast sums of money will be found.

The new research has again focused attention on the extraordinarily high cost of AZT. The manufacturer, Burroughs Wellcome, has made one 20% cut in the price since it was put into general use in March of 1987. The drug now sells wholesale at $1.50 a capsule. The standard prescription is 12 a day at a retail cost of about $8,000 a year. The reduced dosage of five a day, used effectively in the treatment of asymptomatic persons, would cost more than $3,000 a year at retail. Burroughs Wellcome has defended its pricing as essential to funding its continuing research program. But it has drawn sharp criticism, not least because a substantial part of the original research on the basic drug and its clinical testing were funded by the federal government. Pressure for a major price cut is growing, quite understandably.

There is, at this time, no equal to AZT in prolonging the lives of those with HIV infection. An experimental drug, DDI, is going into free distribution pending formal approval as a substitute for those who cannot tolerate AZT, while Bristol-Myers Co., the manufacturer of DDI, has yet to indicate what the price will be when it is finally approved. Neither AZT nor DDI is a cure. The sheer cost of AZT means that, without government subsidy, it is beyond the reach of millions of infected persons. Its extraordinary usefulness in extending lives has created a challenge to public health in the United States that cannot be ignored.