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The cost of removing financial barriers to
treatment uptake and adherence as effective
public health strategies for improving health
and reducing HIV transmission in Australia
Lance Feeney - Positive Life NSW
(No conflicts of interest to declare)
Background
• The Australian Seventh National HIV Strategy 2014-2017
targets
• NSW HIV Strategy 2012-2015: A New Era
• Australian PBS subsidised medicines (patient co-payment)
• Financial stress and cost of ART co-payments are barriers to
treatment uptake and adherence
• PLHIV experience higher rates of co-morbidity
• Decisions about ART initiation and adherence are negatively
impacted by cost of ART and non-ART medications
Background cont.
• A case for Australian Governments reducing the cost burden
of ART, particularly for those experiencing financial stress
• Annual cost of each new HIV infection is $13,800 - $16,300 for
those on 1st or 2nd line ART
• Annual cost for those on 3rd line ART is $19,000
• The life time cost of each new HIV infection is estimated to be
approximately $483,000 - $570,000 (1st/2nd) and $665,000 (3rd
line ART)
Methods
PBS Co-payment rates &
employment percentages
Number of ART items dispensed
per person
Full and Concessional patient cost for ART/non-ART
medications over 12 months
Yearly cumulative full co-payment cost of ARV and non-ARV medications
ANTIRETROVIRALS
1item
Total
221.00
2 items
442.00
3 items
663.00
4 items
884.00
NON-ANTIRETROVIRALS
1 item
2 items
3 items
442.00
884.00
1326.00
4 items
1768.00
5 items
2210.00
Yearly cumulative concessional co-payments costs for ARV and non-ARV medications
ANTIRETROVIRALS
1 item
Total
36.00
2 items
72.00
3 items
108.00
4 items
1441.00
NON-ANTIRETROVIRALS
1 item
2 items
3 items
72.00
144.00
216.00
4 items
288.00
5 items
360.00
Yearly cost to Government of waiving ART co-payments for 10,500
people with diagnosed HIV in NSW - 2014
Employed
Full-time (59.6%) of
10,500 (6,258)
Part-time/other
(18.8%) of 10,500
(1,974)
Concession (21.7%)
of 10,500 (2,278)
Total
70% treatment
uptake
$2,904,337
80% treatment
uptake
$3,319,242
90% treatment
uptake
$3,734,148
100% uptake
$916,133
$1,047,009
$1,177,885
$1,308,762
$172,216
$196,819
$221,421
$246,024
$3,992,686
$4,563,070
$5,133,454
$5,703,840
$4,149,054
Yearly cost to Government of waiving co-payments for 15%-20%
of people with undiagnosed HIV in NSW - 2014
Undiagnosed and
untreated
15% of 10,500
(1,575)
20% of 10,500
(2,100 people)
70% treatment
uptake
$598,903
80% treatment
uptake
$684,460
90% treatment
uptake
$770,018
100% uptake
$798,537
$912,614
$1,026,691
$1,140,768
$855,576
So for less than $6 million per year 90% of all people with diagnosed and
undiagnosed HIV could be treated free
It could cost $5.2 million per year at 80% treatment uptake
Progress in other Australian States and Territories
•  New South Wales • Victoria -
Detailed analysis commissioned by Victorian AIDS Council and Living Positive Victoria
and conducted by Burnet Institute
•
•
•
•
 Queensland –
 South Australia –
Western Australia –
Northern Territory –
Proposal viewed with merit, but yet to be approved for implementation
Positive Life South Australia developing state-based submission
ART co-payments waived
ART co-payments waived
•  Tasmania and the Australian Capital Territory ?
Conclusion
• Mixed result to reduce cART cost burden
• Improving rates of ART in NSW
• But, still PLHIV minority with poorer health, drug and alcohol
and poverty issues
• Achieving 2015 treatment and prevention targets will require
addressing barriers to cART
• A case to build this into the public health response
Acknowledgments
•
•
•
•
•
Jo Watson – NAPWHA (co-author)
Bill Whittaker – NAPWHA
Albion Centre Pharmacy
St. Vincent’s Hospital Pharmacy
PozAction members:
o Queensland Positive People
o Living Positive Victoria
o Positive Life South Australia