Drugs costs

The economic impacts of HIV/AIDS disease have also been analyzed in Europe. Beck (1995) studied the AIDS-related costs in a national AIDS referral center in London. He concluded that share of total drug cost increased between 1985 and 1989 from 5.0% to 30.0%. The median survival time from the date of the diagnosis of AIDS was 14.6 months before the introduction of Zidovudine (1987) and 21.0 months afterwards. 

The introduction of protease inhibitor-based regimens seemed to be responsible for a change within the structure of provider costs. There is some evidence that the share of drugs increased, whereas the importance of hospitalization declined. For instance, Hellinger (1993) estimated that drug costs to account for about 10% of the total provider costs, whereas the inpatient hospitals costs were responsible for some... 

With these findings we can conclude that the drug costs strongly increased since the introduction of HAART. However, other provider costs strongly declined with the introduction of this drug regime, so that the total costs remained stable or declined. HAART is - at least in the short-term analysis given in this literature review - cost-effective. 

Based on two clinics specialized in AIDS treatment, Papaevangelou et al. (1995) calculated lifetime costs per patient in Greece at US 24,160, consisting of drug costs (US 9,022), costs for outpatient care (US 963), and inpatient care (US 14,175). 

Further detailed analyses of the ECA data have been extrapolated to USA national costs (Rice and Miller, 1998). It was calculated that the economic costs of mental disorders in 1990 in the USA totalled US 147.8 billion. Anxiety disorders were the most cosdy, amounting to 46.6 billion, just under a third of the total. Direct costs spent on mental health care totalled 67 billion, of which anxiety disorders accounted for only 11 billion (16.5%). Drug costs were 2191 million, of which anxiety disorders accounted for 1167 million—over half Morbidity costs—the value of goods and services not produced because of mental disorders — amounted to 63.1 billion, with anxiety disorders accounting for 34.2 billion, 54.2% of the total. This reflects the high prevalence of anxiety disorders in the community and the high associated rate of lost productivity. In contrast, patients with affective disorders appeared better able to function (Rice and Miller, 1995). In summary, anxiety disorders are common, disruptive and costly to society drug treatment is a substantial element of treatment costs (11%) compared with, say, schizophrenia (2.2%). 

The pharmacoeconomics of the anxiety disorders has received litde attention. In the past drug costs were largely incurred by use of benzodiazepines, most of which are available in generic forms and are cheap. They are effective and acceptable in the short term. Long-term use is associated with the risk of physical dependence, with an adverse risk—benefit ratio and high cost terms to facilitate withdrawal. There is now a trend towards the use of antidepressants in the anxiety disorders. Clinical experience has been followed by formal trial evaluation. 

Although atypical antipsychotic agents may cost several times as much as traditional antipsychotics, drug costs in schizophrenia account for only 1-4% of the total treatment cost (Knapp, 1997). The argument then is that a small increase in drug costs— say to 10% of total cost—may result in disproportionate savings in the highly expensive direct hospital costs, if clinical trial... 

The evidence base for clinical decisions based on cost-effectiveness for the affective disorders is less clear than for schizophrenia. In bipolar disorder the primary effectiveness of the mainstay treatments, lithium and anticonvulsant pharmacotherapy, is undergoing considerable revision (Bowden et al, 2000). Until this is clarified, cost-effectiveness studies are probably premature. Nevertheless the cost burden in bipolar disorder is qualitatively similar to that in schizophrenia, with in-patient costs being the primary burden and associated social costs in treated patients. The drug costs are even less than those for schizophrenia. In Chapter 5 John Cookson suggests there is little economic evidence to drive prescribing decisions. The in-patient burden does not seem to have altered with the introduction of lithium. The only drug-related study (Keck et al, 1996) showed an obvious difference in treatment costs only when lithium was compared with sodium valproate. Since these are both cheap drugs this is unlikely to influence clinical decisions. The main question is what impact... 

Over the next decade, seniors will spend 1.8 trillion on prescription medications. Medicare proposals to provide a drug benefit for seniors have been suggested to cost 400 billion over a 10-year period. Thus, the most elaborate of the current drug programs will pay only 22% of seniors drug costs. Enhanced use of pharmacoeconomic tenets to select appropriate therapy while considering cost and therapeutic benefits for seniors and others will become even more crucial for clinicians in the future. 

The duration of therapy is controversial and varies by continent. Europeans routinely treat patients for 7 days whereas Americans usually rely on a 14-day regimen. While this seven additional days of therapy improves the absolute cure rate by approximately 9%,14 longer courses decrease compliance and increase drug cost. 

Lyles, A. and F.B. Palumbo (1999), The effect of managed care on prescription drug cost and benefits , PharmacoEconomics, 15, 129—40. 

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