Researchers in the United States have calculated that the diagnosis and treatment of adverse drug effects like neutropenia, diabetes, nephrolithiasis, pancreatitis and the many facets of the lipodystrophy syndrome is costing vast sums that could undermine the cost-effectiveness of HAART if clinicians persist in prescribing drugs with potentially severe side effects.
Groups at Glaxo-Wellcome in the United States and France looked at the costs of severe adverse events (so-called grade 3 and 4 adverse events) and at the costs of lipodystrophy respectively.
The US group calculated the cost of a standard pattern of diagnosis and treatment for around 30 adverse events commonly associated with HAART, and then costed the care on the basis of average costs from 900 US hospitals.
They found that severe drug-related diarrhoea could cost up to $17, 300 to treat, while severe pancreatitis (including hospitalisation) cost up to $26,000 to treat. In comparison, a triple HAART regimen costs around $6,000 to $10,000 a year. However, such severe reactions are infrequent, occurring in around 1%-5% of patients depending on the drug reaction.
The French group looked at the cost of more frequent adverse events related to body fat and metabolic changes, and surveyed French doctors in order to find out how they diagnosed and treated the changes.
They found that every case of fat maldistribution or metabolic abnormalities (including the use of MRI and DEXA scanning) cost around 774 francs to diagnose (approximately £80). Surgical procedures associated with reducing buffalo humps, breast enlargement and truncal obesity were considerably more costly.
Dennett SL et al. The cost of managing abnormal fat distribution and metabolic abnormalities in France. Thirteenth International AIDS Conference, Durban, abstract WePo4251, 2000.
Kauf T et al. Cost of adverse events associated with antiretroviral therapy. Thirteenth International AIDS Conference, Durban, abstract WePo4240, 2000.