Rationing HIV medications: what do patients and the public think about allocation policies?

Attribute framing affects the perceived fairness of health care allocation principles

Health care resource allocation is a central moral issue in health policy, and opinions about it have been studied extensively. Allocation situations have typically been described and presented in a positive manner (i.e., who should receive medical aid). On the other hand, the negative valence allocation situation (i.e., who should not receive medical aid) has been relatively neglected. This paper demonstrates how positive versus negative framing of the exact same health care resource allocation situation can affect the perceived fairness of allocation principles. Participants usually perceived non-egalitarian principles (i.e., need, equity and tenure) to be fairer in positively framed situations (i.e., to deliver health care resources to certain patients) than negatively framed situation (i.e., not to deliver health care resources to other patients). However, framing did not affect the perceived fairness of the equality principle (i.e., a random draw). The paper offers a theoretical explanation for the effect of framing on the perceived fairness of health care resource allocation and discusses implications for both researchers and policy makers.

Perceptions of health, HIV disease, and HIV treatment by patients in 6 regions: analysis of the 2555-person AIDS treatment for life international survey

BACKGROUND

Antiretroviral therapy (ART) has reached millions of HIV-infected patients worldwide, however very little is known about their perceptions about HIV disease and its treatment. The AIDS Treatment for Life International Survey (ATLIS) is the largest sampling of patient perceptions about HIV disease and its treatment, as well as their behaviors, including HIV status disclosure and ART adherence.

METHODS

The International Association of Physicians in AIDS Care (IAPAC) and its survey vendor, Ipsos Insight Health, conducted a convenience-sample survey of 2555 treated and untreated HIV-infected adults recruited by diverse means from 6 regions: North America, Latin America, the Caribbean, Europe, Asia/Pacific, and sub-Saharan Africa.

FINDINGS

Nearly three quarters of respondents were taking prescription medications for HIV infection or related diseases. Participants reported generally good overall health and high degrees of satisfaction with current antiretroviral drugs, though approximately half of respondents voiced concern about potential ART toxicity and 39.4% reported switching their antiretroviral regimen specifically because of treatment-associated side effects. About 1 in 5 respondents never took medications for HIV and AIDS. Among the three quarters of respondents currently taking medications, 37% are taking their first prescribed antiretroviral regimen, and 24% have switched from a first-line antiretroviral regimen. Three quarters of respondents believe ART will help them live a long life, and treatment-experienced respondents expressed this view significantly more often than untreated respondents. Large majorities of respondents in Latin America, Asia, and South Africa want to know more about ART, while half or fewer in these countries correctly explained the meaning of undetectable HIV RNA (defined as <50 HIV RNA copies/mL of plasma) or knew their CD4 cell count.

Program savings associated with switching testosterone intramuscular injections to topical gel in HIV infected males

BACKGROUND

HIV-1 infected male patients commonly require testosterone supplementation and intramuscular testosterone (IM) is the most frequently used supplementation method. Currently, the economic burden of testosterone supplementation is borne to a large degree by the clinic providing services to the HIV infected male. Increasingly, clinics are seeking alternative methods to provide supplementation. This analysis describes the economic trade-offs associated with the utilization of topically applied testosterone supplement relative to current supplementation techniques within the clinic setting.

METHODS

Twenty-three patients that had been receiving IM were switched to topical testosterone gel (TOP). A 1-month time-and-motion study, identification of IM administration specific supplies, and costs for acquisition and disposal of these supplies were conducted or gathered to quantify costs of providing bi-weekly IM to patients. The analysis describes potential resource savings by switching 23 HIV patients served in a safety-net provider setting from IM to TOP. The analysis considers both a pre and post-evaluation period whereby patients received IM in the pre-evaluation period and then were switched to TOP in the follow-up period. Economic assessments considered direct medical costs for the preparation and administration of the product but did not incorporate other outcomes in the analyses.

RESULTS

Only one of 23 patients switched experienced recurrence of symptoms and no patients developed adverse effects associated with the switch. In contrast, substantial resources could be realized with the utilization of the topically applied testosterone relative to the injectable formulations with approximately $80,938 fewer dollars spent on provision of IM.

CONCLUSIONS

Switching patients from IM to TOP resulted in no deleterious affects and is estimated to have saved the clinic considerable resources, even if TOP had to be provided by the clinic.