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Even with appropriate monitoring, there are certainly some additional costs down the road for those who do not seroconvert but do develop osteoporosis, heart, kidney or other problems from taking the treatment. We continue to learn more about the side effects of the treatments in people who have HIV; there is no reason to think those taking treatments who do not HIV won't have any side effects. None of those costs are included in my hypothetical $10,000 per year cost of treatment.
I looked at the NEJM report again and note that the median time on the study was 1.2 years. So that's the period to consider rather than 18 months. The costs would be less than $59,200 but not by much. Also it's unlikely that all would comply with regular monitoring that anyway may not be available everywhere. Any savings would probably be offset by additional costs down the line from the consequences of inadequate monitoring.
So if 44 people are required to be treated for 18 months to prevent one infection, that translates into nearly five years (592 months) of treatment to prevent one infection. In a hypothetical situation where treatment--including the very necessary doctor's visits and lab work--costs $10,000/year, would that mean it costs $59,200 to prevent an infection (in that 18 month window) via PrEP. I realize treatment costs are highly variable, but otherwise is my math correct?
These kind of "number games" go on all the time in science. The state of science in this country is just depressing. Our medical scientists and doctors are willing slaves to the pharmaceutical companies. The biggest problem is education though and the dumbing down of the public. People don't understand math anymore, not even on an elementary level. A simple semester or two of statistics would clear a lot of the confusion up. It's a sad sad state. AIDS activists are usually so knee jerk about everything; they embrace everything, instantly, that seems even slightly like it may be beneficial. AIDS activists, in my experience, although their hearts are in the right place are the biggest bunch of morons I have ever met.
John Eisenhans
Too bad Sonnabend and Strub are stll using numbers they know are inaccurate to begin with. It doesn't matter how you parse and manipulate the data. If you know the data you start with are incorrect, you're still lying. To his credit, however, Sonnabend hedges: "where the insertive partner cannot maintain an erection with a condom, or where a couple feels that intimacy is diminished with a condom. We should be supportive of PrEP." In other words, the doctor will allow that chemoprophyllaxis may be worthwhile for anyone who thinks condoms suck (and not in a good way). It would be interesting to see some believable data on how many men fall outside this gaping exception. But ultimately what it comes down to is this: freedom of choice and individual responsibility. If I get pregnant and don't want to be, should I have the option of terminating the pregnancy or not. From the logic of their recent arguments, it is clear that Sonnabend, Strub and Hoffman think not. Birth control, especially abortion, is just a pricey sex toy to them. Likewise for fertility medicine. If I'm having trouble conceiving in a world of seven billion, should I really be allowed to spend the huge sums of money needed to make the miracle happen for me? Or more to the point, if I have HIV and find myself pregnant or wanting to be, should I really have any options?
August 5, 2011