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)

MethodsPBS 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 NON-ANTIRETROVIRALS 1item 2 items 3 items 4 items 1 item 2 items 3 items 4 items 5 items Total 221.00 442.00 663.00 884.00 442.00 884.00 1326.00 1768.00 2210.00

Yearly cumulative concessional co-payments costs for ARV and non-ARV medications

ANTIRETROVIRALS NON-ANTIRETROVIRALS 1 item 2 items 3 items 4 items 1 item 2 items 3 items 4 items 5 items Total 36.00 72.00 108.00 1441.00 72.00 144.00 216.00 288.00 360.00

Yearly cost to Government of waiving ART co-payments for 10,500 people with diagnosed HIV in NSW - 2014

Employed 70% treatment uptake

80% treatment uptake

90% treatment uptake

100% uptake

Full-time (59.6%) of 10,500 (6,258)

$2,904,337 $3,319,242 $3,734,148 $4,149,054

Part-time/other (18.8%) of 10,500 (1,974)

$916,133 $1,047,009 $1,177,885 $1,308,762

Concession (21.7%) of 10,500 (2,278)

$172,216 $196,819 $221,421 $246,024

Total $3,992,686 $4,563,070 $5,133,454 $5,703,840

Yearly cost to Government of waiving co-payments for 15%-20% of people with undiagnosed HIV in NSW - 2014

Undiagnosed and untreated

70% treatment uptake

80% treatment uptake

90% treatment uptake

100% uptake

15% of 10,500 (1,575)

$598,903 $684,460 $770,018 $855,576

20% of 10,500 (2,100 people)

$798,537 $912,614 $1,026,691 $1,140,768

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 – Proposal viewed with merit, but yet to be approved for implementation

• South Australia – Positive Life South Australia developing state-based submission

• Western Australia – ART co-payments waived

• Northern Territory – 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 Peopleo Living Positive Victoriao Positive Life South Australia