By Amy Norton

NEW YORK, Mar 14 (Reuters Health) - While HIV drug "cocktails" clearly help many patients to lead longer and healthier lives, two new studies confirm that the expensive therapy pays off in dollars and cents as well.

The medications cost up to $15,000 a year per patient, but the studies show the drugs save money by keeping patients healthier and out of the hospital. The findings are published in the March 15th issue of The New England Journal of Medicine.

"The point is that these therapies extend life and improve the quality of life," Dr. Kenneth A. Freedberg of Massachusetts General Hospital in Boston said in an interview with Reuters Health. "While the drugs are expensive, they're also very effective."

Since 1996, when HIV drugs known as protease inhibitors were introduced, the standard of care in the US has been to fight HIV infection with potent combinations of these drugs. The tactic is called highly active antiretroviral therapy, or HAART. Some patients with AIDS, including minorities and people with government health insurance, don't have full access to HAART because of its high cost.

But, according to Freedberg, studies such as his and one led by Dr Samuel A. Bozzette of the University of California, San Diego, show it's cheaper to pay for HAART than for the complications caused by HIV.

"I think money is what moves policy," he said. Government programs that help the poor pay for HIV drugs--such as the AIDS Drug Assistance Program (ADAP)--may be able to use these study findings to argue for more funding, Freedberg noted.

Freedberg and his colleagues used data from major clinical trials of HIV drugs to compare the cost of treatment with increases in patients' life expectancy. The cost of extending an HIV patient's life for one year was similar to that of prolonging a heart-attack patient's life for the same amount of time. And it was more cost-effective, on average, than treating high cholesterol.

Bozzette's team looked at nearly 3,000 HIV patients and found that after the introduction of HAART, hospital costs fell by more than 40% in 1997. So although drug costs climbed, total healthcare costs for HIV patients had declined from $20,300 per patient in 1996 to $18,300 in 1998, the researchers report.

However, the effects were not equal among all groups. Bozzette and his colleagues found that hospital care remained the biggest treatment cost for women, blacks and patients on public health insurance.

These studies, according to an accompanying editorial, "focus attention once again on the fragmented system of care for HIV-infected patients in the United States." According to journal editor Dr. Robert Steinbrook, the availability of HIV drugs and care varies from state to state, and programs like ADAP that pay only for drugs cannot benefit from declines in other HIV care costs.

State and federal funding for ADAPs and Medicaid drug coverage should increase, Steinbrook contends, but the federal government could make funding increases dependent on the quality of the state programs. In addition, he writes, government programs should negotiate with drug companies for deeper discounts in HIV drugs.

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