Cost-effectiveness of chemoprophylaxis after occupational exposure to HIV

Abstract

Under most reasonable assumptions, chemoprophylaxis with zidovudine, lamivudine, and indinavir following moderate- to high-risk occupational exposures is cost-effective for society. If combination PEP is minimally more effective than zidovudine PEP, then the added expense of including lamivudine and indinavir in the drug regimen is clearly justified.

HIV transmission and the cost-effectiveness of methadone maintenance

“…Treatment with trimethoprim-sulfamethoxazole for Pneumocystis carinii pneumonia and toxoplasmosis in patients who are HIV infected with CD4 cell counts of 200/µL or less has a cost-effectiveness ratio of $16000 per QALY gained, 78 prophylaxis for Mycobacterium avium complex in patients who are HIV infected with CD4 cell counts less than 50/µL has a cost-effectiveness ratio between $35 000 per QALY gained and $74 000 per QALY gained, 78 and prophylaxis for cytomegalovirus retinitis has a ratio of at least $160000. 79,80 Chemoprophylaxis following high-risk occupational exposure to HIV has a cost-effectiveness ratio of $37 000, 81 and that following sexual exposure to HIV has a cost-effectiveness ratio of $6300. 82 Other HIV prevention programs have been found to have more favorable cost-effectiveness ratios than we estimated for expansion of methadone maintenance programs; for example, an intervention to increase condom use among high-risk urban women has a ratio of $2000, 83 and a skills training program for men who have sex with men was estimated to be cost saving.…”

Emergency Department Management of Occupational Exposures: Cost Analysis of Rapid HIV Test

“…This conservative approach used in a community with a low incidence of HIV is supported by Pinkerton, who concluded that "chemoprophylaxis with zidovudine, lamivudine, and indinavir following moderate-to-high risk occupational exposures is cost-effective for society. 6 Therefore, our standard postexposure medications include zidovudine 600 mg per day, lamivudine 300 mg per day, and indinavir 800 mg every 8 hours.…”

Post-exposure prophylaxis following non-occupational exposure to HIV: risks, uncertainties, and ethics

“…A month's supply of triple combination therapy costs approximately £650 (as well as additional toxicity and inconvenience). However, a study showed that chemoprophylaxis with AZT, 3TC, and indinavir following moderate-to-high risk exposures is cost-effective for society 22 . Given the lack of information on non-occupational PEP, its effectiveness has not been established.…”