{"id":1859,"date":"2015-08-12T14:10:42","date_gmt":"2015-08-12T18:10:42","guid":{"rendered":"http:\/\/allphasepharma.com\/dir\/?p=1859"},"modified":"2015-08-12T14:30:28","modified_gmt":"2015-08-12T18:30:28","slug":"the-beauty-of-science-no-need-to-think-about-costs-when-you-live-in-an-ivory-tower","status":"publish","type":"post","link":"https:\/\/allphasepharma.com\/dir\/2015\/08\/12\/1859\/the-beauty-of-science-no-need-to-think-about-costs-when-you-live-in-an-ivory-tower\/","title":{"rendered":"The Beauty of Science: No Need to Think About Costs When You Live in An Ivory Tower"},"content":{"rendered":"<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-1860\" src=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/08\/Instight-NEJM-blog.jpg?resize=530%2C149&#038;ssl=1\" alt=\"Instight NEJM blog\" width=\"530\" height=\"149\" srcset=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/08\/Instight-NEJM-blog.jpg?w=640&amp;ssl=1 640w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/08\/Instight-NEJM-blog.jpg?resize=300%2C84&amp;ssl=1 300w\" sizes=\"auto, (max-width: 530px) 100vw, 530px\" \/><\/p>\n<p>The recently published INSIGHT trial showed that starting HIV therapy earlier rather than later has benefit for patients <sup>1<\/sup>. This should not come as a surprise considering the excellent suppressive power of current triple regimens.\u00a0 The trial which enrolled 4685 HIV infected patients was stopped prematurely when an interim analysis showed (with an impressive P-value) that outcomes were statistically improved, in a clinically meaningful manner, by starting therapy early irrespective of CD4 count.<\/p>\n<p>Current practice which delays treatment until the CD4 count drops to 350 will almost certainly be replaced soon with this new regimen which makes every HIV positive patient a candidate for treatment at the time of diagnosis.<\/p>\n<p>It also brings to mind the Pareto\u2019s principle &#8211; also known as the 80\/20 rule:\u00a0 we pay a very high price to squeeze out the last 20% of benefit with our therapies, be that cholesterol-lowering with statins or viral load suppression in HIV.<\/p>\n<p>Let us review the situation in an unbiased fashion.\u00a0 The benefits of early treatment initiation in terms of \u2018serious clinical problems averted\u2019 (see list below) seem real.\u00a0 The study findings are internally consistent all showing a similar positive trend in subset analyses favoring early initiation of HAART.<\/p>\n<p>Now, stepping out of the ivory tower of science and looking at the cost consequences, we can make some crude estimates:<\/p>\n<ul>\n<li>In this study, the number \u2018needed to treat\u2019 (NNT) was approx. 43; in other words, one would have to treat this many patients for 1 to benefit from the intervention;<\/li>\n<li>An effective therapy is available which costs at least $20-25k per year\u00a0<a href=\"#_ftn1\" name=\"_ftnref1\">[2, 3]<\/a>; it would now be given on average 3 years earlier than with current practice.<\/li>\n<\/ul>\n<p>Hence, the costs for 1 \u2018serious clinical problem averted\u2019 is<\/p>\n<p style=\"text-align: center;\"><strong><span style=\"color: #800000;\">$ 20k x 3 years x 43 patients = $ 2.56 mio<\/span><\/strong><\/p>\n<p>Clearly, there are indirect benefits like reduced transmission of HIV which we did not factor in.\u00a0 However, on the flip side, we also chose to disregard the additional costs from doctor visits, drug monitoring, and labs like VL and CD4 level determinations which patients incur while on therapy during an extra 3 years.<\/p>\n<p>Importantly, the number of deaths averted from any cause was 9; there were 12 in the early treatment and 21 occurred in the delayed treatment groups (P=0.13).<\/p>\n<p>Besides the clinical results we are interested in the financial aspects and the societal consequences of the INSIGHT study.\u00a0 <strong><span style=\"color: #000080;\">We are interested your esteemed opinion.<\/span><\/strong><\/p>\n<p>Here is today\u2019s question we ask you to vote on:<\/p>\n<p><span style=\"color: #003366;\">Health progress and the R&amp;D it required comes at a cost.\u00a0 Society and Health Care providers are now routinely asked to pay premium prices for better medicines.\u00a0 In your opinion, given the results of the INSIGHT study , is the cost of an earlier HIV treatment justified?\u00a0<\/span><span style=\"color: #000080;\">[poll id=&#8221;4&#8243;]<\/span><\/p>\n<p>Independent of your vote, we all can agree that an ounce invested in prevention stands to reap huge long-term cost savings.\u00a0 Research into HIV vaccines and curative approaches should be a top priority as it would have a tremendous impact on health care spending.<\/p>\n<hr \/>\n<p>Here the LIST of SERIOUS PROBLEMS AVERTED from the INSIGHT STUDY:<\/p>\n<ul>\n<li>Death from any cause<\/li>\n<li>AIDS-defining event<\/li>\n<li>Myocardial infarction, coronary revascularization or stroke<\/li>\n<li>end-stage renal disease\u00a0or renal transplant<\/li>\n<li>decompensated liver disease<\/li>\n<\/ul>\n<hr \/>\n<p>Here some more FACTS about HIV \/ AIDS:<\/p>\n<ul>\n<li>HIV incidence of new cases for the US is approx. 50,000 patients \/ year. These plus all HIV positive patients currently untreated are now eligible for HIV therapy.<\/li>\n<li>According to The Kaiser Family Foundation, Medicaid spending on HIV totalled $5.3 billion, which is a third of all federal HIV funding \u2013 in 2012.<a href=\"#_ftn1\" name=\"_ftnref1\">[2]<\/a> The Ryan White Act provides additional billions of funding: $2.3 billion were requested in the Budget for 2015.<\/li>\n<li>None of the existing programs cover all the uninsured that are candidates for delayed therapy, let alone for immediate therapy.<\/li>\n<\/ul>\n<p><strong>References:<br \/>\n<\/strong><a href=\"#_ftnref1\" name=\"_ftn1\">[1]<\/a> The INSIGHT START Study Group,\u00a0 NEJM\u00a0 July 20, 2015<br \/>\n<a href=\"#_ftnref1\" name=\"_ftn1\">[2]<\/a> http:\/\/www.avert.org\/hiv-treatment-usa.htm<br \/>\n<a href=\"#_ftnref1\" name=\"_ftn1\">[3]<\/a> The actual cost of a triple regimen of Prezista, Truvada, and Norvir amounts to\u00a0$3000\/month, or $36k\/year.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The recently published INSIGHT trial showed that starting HIV therapy earlier rather than later has benefit for patients 1. This should not come as a surprise considering the excellent suppressive power of current triple regimens.\u00a0 The trial which enrolled 4685 HIV infected patients was stopped prematurely when an interim analysis <a class=\"more-link\" href=\"https:\/\/allphasepharma.com\/dir\/2015\/08\/12\/1859\/the-beauty-of-science-no-need-to-think-about-costs-when-you-live-in-an-ivory-tower\/\">Continue reading <span class=\"screen-reader-text\">  The Beauty of Science: No Need to Think About Costs When You Live in An Ivory Tower<\/span><span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":1860,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[140,227,3,18],"tags":[1262,1259,1260,403,50,1265,672,49,1072,1258,1269,1270,508,1263,1267,1264,1261,1266,1268,1068,669,668],"class_list":["post-1859","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-interesting_facts","category-recent_literature","category-the_news","category-the_viewpoint","tag-8020-rule","tag-aids","tag-aids-defining-event","tag-antibiotic-blog","tag-cd4-count","tag-cost-of-hiv-medicines","tag-haart","tag-hiv","tag-hiv-treatment","tag-insight-study","tag-kaiser-family-foundation","tag-medicaid-spending-on-hiv","tag-nejm","tag-nnt","tag-norvir","tag-number-needed-to-treat","tag-pareto-principle","tag-prezista","tag-ryan-white-act","tag-truvada","tag-viral-load","tag-vl"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/08\/Instight-NEJM-blog.jpg?fit=640%2C180&ssl=1","jetpack_shortlink":"https:\/\/wp.me\/p4KWFr-tZ","jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":222,"url":"https:\/\/allphasepharma.com\/dir\/2014\/05\/30\/222\/hiv-therapy-guidance-recommendations-diverge-show-us-bias\/","url_meta":{"origin":1859,"position":0},"title":"HIV Therapy Guidance Recommendations Diverge, Show US Bias","author":"Harald","date":"May 30, 2014","format":false,"excerpt":"US doctors seem to be very willing to start drugs earlier in disease, while their EU colleagues are slower and more conservative.\u00a0 Recent examples: the ever-wider indication for statins, the disproportionate uptake of drugs for attention-deficit \/ hyperactivity and opioids for pain relief.\u00a0 The new US HIV treatment guidelines are\u2026","rel":"","context":"In &quot;The Viewpoint&quot;","block_context":{"text":"The Viewpoint","link":"https:\/\/allphasepharma.com\/dir\/category\/the_viewpoint\/"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":1741,"url":"https:\/\/allphasepharma.com\/dir\/2015\/07\/17\/1741\/does-the-taxpayer-get-rewarded-for-funding-studies\/","url_meta":{"origin":1859,"position":1},"title":"Does The Taxpayer Get Rewarded For Funding Such Studies?","author":"Harald","date":"July 17, 2015","format":false,"excerpt":"Cabotegravir (S-1265744) is an integrase inhibitor similar to dolutegravir. \u00a0When formulated as a long-acting drug using crystalline nanoparticle technology it is called GSK'744 LAP.\u00a0 When injected intramuscularly, '744 LAP it has a half-life of >1 month which makes it ideally suited for PrEP\u00a0of HIV for high-risk patients who nowadays are\u2026","rel":"","context":"In &quot;Did you know...?&quot;","block_context":{"text":"Did you know...?","link":"https:\/\/allphasepharma.com\/dir\/category\/interesting_facts\/"},"img":{"alt_text":"LAP HIV Drugs - slider copy","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/07\/LAP-HIV-Drugs-slider-copy.jpg?resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/07\/LAP-HIV-Drugs-slider-copy.jpg?resize=350%2C200 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/07\/LAP-HIV-Drugs-slider-copy.jpg?resize=525%2C300 1.5x"},"classes":[]},{"id":1590,"url":"https:\/\/allphasepharma.com\/dir\/2015\/06\/22\/1590\/tenofovir-bmd-and-monitoring-of-renal-function\/","url_meta":{"origin":1859,"position":2},"title":"Tenofovir, BMD and Monitoring of Renal Function","author":"Harald","date":"June 22, 2015","format":false,"excerpt":"The approved tenofovir \/ Viread label lists not only standard\u00a0nucleoside-class side effects but also\u00a0\u2013 since an update in 2012 \u2013 makes mention of diminished bone mineral density (BMD) in the Warnings \/ Precautions section. Demonstrating that a particular drug affects BMD in patients who are already at an increased risk\u2026","rel":"","context":"In &quot;Recent Literature&quot;","block_context":{"text":"Recent Literature","link":"https:\/\/allphasepharma.com\/dir\/category\/recent_literature\/"},"img":{"alt_text":"BMD TDF","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/06\/BMD-TDF.jpg?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":1112,"url":"https:\/\/allphasepharma.com\/dir\/2014\/11\/08\/1112\/2014-the-year-that-changed-the-landscape-of-hcv-therapy\/","url_meta":{"origin":1859,"position":3},"title":"2014: The Year That Changed The Landscape of HCV Therapy","author":"Harald","date":"November 8, 2014","format":false,"excerpt":"It was d\u00e9j\u00e0 vu all over again, albeit compressed in time: when the race started to replace PegIFN+RBV\u00a0for the treatment of HCV infection, the learnings from HIV drug development and the lessons with HAART provided an excellent template for quick and efficient development. There was early consensus that a search\u2026","rel":"","context":"In &quot;The News&quot;","block_context":{"text":"The News","link":"https:\/\/allphasepharma.com\/dir\/category\/the_news\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/11\/All-New-HCV-slider.jpg?fit=640%2C200&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/11\/All-New-HCV-slider.jpg?fit=640%2C200&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/11\/All-New-HCV-slider.jpg?fit=640%2C200&ssl=1&resize=525%2C300 1.5x"},"classes":[]},{"id":5814,"url":"https:\/\/allphasepharma.com\/dir\/2025\/11\/27\/5814\/obeldesivir-fails-in-yet-another-study\/","url_meta":{"origin":1859,"position":4},"title":"Obeldesivir Fails in Yet Another Study","author":"Harald","date":"November 27, 2025","format":false,"excerpt":"There are studies that are bound to succeed, and those that are likely to fail.\u00a0 A failed trial is nothing to be proud of \u2013 and in this case, it was a gamble against overwhelming odds.\u00a0 We feel the Gilead marketing department was pushing their luck big time with this\u2026","rel":"","context":"In &quot;Recent Literature&quot;","block_context":{"text":"Recent Literature","link":"https:\/\/allphasepharma.com\/dir\/category\/recent_literature\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/11\/IDSA-Covid-Guideline.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/11\/IDSA-Covid-Guideline.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/11\/IDSA-Covid-Guideline.jpg?resize=525%2C300&ssl=1 1.5x"},"classes":[]},{"id":708,"url":"https:\/\/allphasepharma.com\/dir\/2014\/08\/09\/708\/did-you-know-that\/","url_meta":{"origin":1859,"position":5},"title":"Did you know that\u2026","author":"Harald","date":"August 9, 2014","format":false,"excerpt":"A Phase 1 study evaluating tigecycline (Tygacil\u00ae) to treat refractory Acute Myeloid Leukemia is currently underway? [1] Niacin extended release tablets (nicotinic acid, Niaspan\u00ae) was associated with a significantly higher rate of infections (appendicitis, bronchitis, cellulitis) compared to placebo in the AIM-HIGH trial which enrolled over 3400 patients? [2] Macrolides\u2026","rel":"","context":"In &quot;Did you know...?&quot;","block_context":{"text":"Did you know...?","link":"https:\/\/allphasepharma.com\/dir\/category\/interesting_facts\/"},"img":{"alt_text":"","src":"http:\/\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/08\/jpg","width":350,"height":200},"classes":[]}],"jetpack_likes_enabled":true,"_links":{"self":[{"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/posts\/1859","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/comments?post=1859"}],"version-history":[{"count":6,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/posts\/1859\/revisions"}],"predecessor-version":[{"id":1866,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/posts\/1859\/revisions\/1866"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/media\/1860"}],"wp:attachment":[{"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/media?parent=1859"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/categories?post=1859"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/tags?post=1859"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}