| Projection Methods |
| Ryan White CARE Act, Title II AIDS Drug Assistance Program (ADAP) |
Annual Health Care
Costs and Ryan White CARE Act - ADAP Needs | |
| Introduction to the ADAP Budget Projection Model, Fiscal Year 2000 | ||
The ADAP Working Group is a unique ad hoc coalition of HIV/AIDS community-based organizations, biotechnology, pharmacy and pharmaceutical research companies. Our mission is to ensure adequate access to HIV/AIDS-related therapies through the AIDS Drug Assistance Program (ADAP), funded under Title II of the Ryan White CARE Act.
The ADAP Working Group believes that the enclosed budget projection provides an accurate representation of the cost of providing a basic standard of HIV/AIDS care to those on ADAP in Fiscal Year 2000, which runs April 1, 2000 - March 31, 2001.
The cost of treating a person with AIDS on Medicaid can be upwards of $40,000 a year.* In fiscal 2000, adequate treatment per person on ADAP will average little more than $10,000 for the year, including costs for treating and preventing opportunistic infections. Without adequate ADAP funding, uninsured and underinsured people with HIV will have to wait until they are sick and disabled in order to qualify for Medicaid and receive the treatment that could have prevented their illness. This is clearly unsound health care policy.
The impact of multi-drug anti-HIV therapy has been well publicized over the past two years. The many incremental gains in the prevention and treatment of opportunistic infections have also made a significant contribution to extending and improving the lives of people with AIDS. The stunning 47% drop in deaths from AIDS nationally in 1997 is the most recent testament to these facts. Also the National Institutes of Health and the Public Health Service have released guidelines on the use of antiretroviral therapy that promise to further improve the standard of care for people with HIV and AIDS.
The ADAP Working Group believes that we cannot afford to deny optimum HIV and AIDS treatment to all those that could benefit from it. The ADAP population is particularly vulnerable, often depending on a fractured system of care and on other vital Ryan White services. They should not have to decline into disability to receive the treatments they need.
The following summarizes the ADAP Budget Projections:
| FY 1999 | |
| Projected total ADAP budget need for FY 1999: | $790,141,711 |
| Projected base budget for FY 1999: | $776,428,541** |
| Current projected FY 1999 shortfall: | ($ 13,713,170)*** |
| Projected ADAP budget need for FY 2000: | $902,956,983 |
| Projected base budget for FY 2000: | $790,154,340**** |
| Current projected ADAP shortfall for FY 2000: | ($112,802,643) |
| To address this shortfall we project needs as follows: | |
| Federal Share (80%*****): | +$ 90,242,114 |
| N.B. The President's FY 1999 budget request already proposes a $35 million increase over the FY '99 $461 million in "targeted ADAP" funds. | |
| State Share (20%*****): | +$ 22,560,529 |
Projection Methods
A computer model, developed by respected
pharmacoeconomists, was used to estimate the cost of providing the
standard of care to these utilizing ADAP clients on a month-by-month basis
out to March 2001. The same model has been utilized by the ADAP Working
Group to project ADAP need for the past three years.
The model uses real world information about the immune system status of ADAP clients to project the need for preventive and acute treatment with outpatient drugs. The expected incidence of illness is based on an analysis of data from the Multicenter AIDS Cohort Study (MACS) by Bacellar et al (Journal of Infectious Disease 1994;170). The same model has predicted individual state ADAP expenditures within 5% of the actual totals. A total of 22 states have utilized this model for fiscal projection purposes.
The model makes assumptions about antiretroviral therapy as described in the new NIH/PHS Guidelines. In addition to their basis in the new NIH/PHS Guidelines, these projections mirror current trends in State ADAPs.
The model cannot anticipate the changes and refinements in the standard of care that may occur within the timeframe of this projection. The ADAP Working Group will update the projection model whenever new and validated information that impacts the model becomes available.
The following slides provide more details on the methodology and the results.
| FY 2000 ADAP Budget Projections |
| archives: 1997-1999 Summary & Projections |
| working group | Last modified: 7/2/99 |
Assistance Program
Advocacy Coalition
1775 "T" St., NW
Washington DC 20009
Ph: (202) 588-1775
Fax: (202) 588-8868
Email: mailto:adap_wg@aol.com
Agouron Pharmaceuticals, Inc.
AIDS Action Council
AIDS Foundation of Chicago
AIDS Healthcare Foundation
AIDS Project Los Angeles
AIDS Treatment Data Network
Bristol Meyers Squibb
Celgene Corporation
Cities Advocating Emergency AIDS Relief Coalition
COVANCE Inc.
Du Pont Merck
Gilead Sciences
Glaxo Wellcome
Hoffman LaRoche
Immune Response Corp.
International Association of Physicians in AIDS Care
Log Cabin Republicans
Merck & Co.
Mothers' Voices
National AIDS Treatment Advocacy Project
National Association of People with AIDS
PAREXEL International
Pharmacia and Upjohn, Inc.
Project Connect
Project Inform
Roxane Laboratories, Inc.
San Francisco AIDS Foundation
Serono Laboratories
Stadtlander's Pharmacy
The National Native American AIDS Prevention Center
Title II Community AIDS Network
Treatment Action Group
Triangle Pharmaceuticals
1/98
Co-chairs
William E. Arnold | Dorothy A. Keville