Cost Effectiveness of ‘On Demand’ Hiv Pre-Exposure Prophylaxis for Non-Injection Drug-Using Men Who Have Sex with Men in Canada

Ouellet, Estelle; Durand, Madéleine; Guertin, Jason R.; LeLorier, Jacques; Tremblay, Cécile

doi:10.1155/2015/964512

Cited by 43 publications

(53 citation statements)

References 32 publications

(32 reference statements)

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“…Our conclusion on the potential cost-savings with HIV vaccines is consistent with Long et al in scenarios with similar assumptions [56]. The results from this analysis differ from a recent economic analysis of Canadian MSM where PrEP was cost-saving in almost all scenarios [57]. The different result may be due to lower Canadian drug costs and the selection of HIV incidence rates, as the Canadian study applied a constant number needed to treat (NTT) from a high-risk Peruvian population with 5% annual HIV incidence while our analysis parameterized baseline infection rates to age-specific CDC HIV incidence in the US.…”

Section: Discussionsupporting

confidence: 82%

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

Adamson¹,

Carlson²,

Kublin³

et al. 2017

Preprint

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This economic evaluation aims to support policy-making on the combined use of preexposure prophylaxis (PrEP) with HIV vaccines by evaluating the potential cost-effectiveness of implementation that would support the design of clinical trials for assessment of combined product safety and efficacy. The target study population is a cohort of men who have sex with men (MSM) in the United States. Policy strategies considered include standard HIV prevention, daily oral PrEP, HIV vaccine, and their combination. We constructed a Markov model based on clinical trial data and published literature. We used a payer perspective, monthly cycle length, a lifetime horizon, and a 3% discount rate. We assumed a price of $500 per HIV vaccine series in the base case. HIV vaccines dominated standard care and PrEP. At current prices,PrEP was not cost-effective alone or in combination. A combination strategy had the greatest health benefit but was not cost-effective (ICER=$463,448/QALY) as compared to vaccination alone. Sensitivity analyses suggest a combination may be valuable for higher-risk men with good adherence. Vaccine durability and PrEP drug prices were key drivers of cost-effectiveness. Results suggest that boosting potential may be key to HIV vaccine value.

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Section: Discussionsupporting

confidence: 82%

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

Adamson¹,

Carlson²,

Kublin³

et al. 2017

Preprint

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show abstract

“…Although a formal economic analysis is outside the scope of this study, the increased efficiency predicted by our findings will translate into a higher cost-effectiveness for PrEP. Our epidemiological model results may be incorporated into a cost-effectiveness analysis, as others have done [34]. Overall, taking into account the direct and indirect effects, implementing PrEP based on the indications in the CDC guidelines strikes a good balance between impact and efficiency according to our study, with 33% of infections averted and an NNT of 25.…”

Section: Discussionmentioning

confidence: 63%

Impact of the Centers for Disease Control's HIV Preexposure Prophylaxis Guidelines for Men Who Have Sex With Men in the United States

Jenness¹,

Goodreau²,

Rosenberg³

et al. 2016

J Infect Dis.

179

178

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Background. Preexposure prophylaxis (PrEP) is effective for preventing human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) within trial settings. Population impact will depend on clinical indications for PrEP initiation, coverage levels, and drug adherence. No modeling studies have estimated the impact of clinical practice guidelines for PrEP issued by the Centers for Disease Control and Prevention (CDC).Methods. Mathematical models of HIV transmission among MSM were used to estimate the percentage of infections averted (PIA) and the number needed to treat (NNT) under behavioral indications of the CDC's PrEP guidelines. We modeled the contribution of these indications while varying treatment coverage and adherence.Results. At 40% coverage of indicated MSM over the next decade, application of CDC guidelines would avert 1162 infections per 100 000 person-years, 33.0% of expected infections. The predicted NNT for the guidelines would be 25. Increasing coverage and adherence jointly raise the PIA, but reductions to the NNT were associated with better adherence only.Conclusions. Implementation of CDC PrEP guidelines would result in strong and sustained reductions in HIV incidence among MSM in the United States. The guidelines strike a good balance between epidemiological impact (PIA) and efficiency (NNT) at plausible scale-up levels. Adherence counseling could maximize public health investment in PrEP by decreasing the NNT.

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“…In terms of the type of mathematical model used in these seven studies, one used a static decision model (24), three a dynamic deterministic compartmental model (25)(26)(27), one a dynamic stochastic microsimulation model (28), while two did not use mathematical models, either because they simply used the number needed to treat to estimate the average cost of the PrEP interventions to prevent one infection (29) or estimated the resources required to deliver PrEP and did not evaluate the costeffectiveness of introducing it (30). The difference between static and dynamic models is that static models, typically used in health economics, do not take into account the fact that HIV is an infectious diseases and therefore that by preventing directly one infection, more (secondary) infections are likely to be averted(31).…”

Section: Recent Studies: Search Criteria and Summary Modelling Considmentioning

confidence: 99%

“…Of the seven studies we identified, three were among MSM (24,25,29), three in heterosexual sero-different couples (26)(27)(28) and one in the general population attending primary health care clinics (30). Those conducted among MSM were all North American -from the US in general (24), Los Angeles (25) and Canada (29). The studies that focussed on sero-different couples were conducted from an African perspective -South Africa(28), Nigeria (26) and Uganda (27) and finally there was one based on attendees at primary health care clinics in South Africa (30).…”

Section: Recent Studies: Model Comparisons and Main Epidemiological Amentioning

confidence: 99%

“…The effectiveness of PrEP against HIV was assumed to be 44% by Chen & Dowdy and Ouellet et al (24,29), based on the IPrEx study conducted among MSM in several countries including the US (1) (92% in an alternative scenario in Chen&Dowdy), 70% (range: 44-90%) by Mitchell et al(26), 90% by Jewell et al (28) and 92% (range: 77%-98%) by Ying et al (27), all based on the Partners PrEP study (3).…”

Section: Recent Studies: Model Comparisons and Main Epidemiological Amentioning

confidence: 99%

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What do we know about the cost–effectiveness of HIV preexposure prophylaxis, and is it affordable?

Cambiano¹,

Miners

Phillips³

2016

Current Opinion in HIV and AIDS

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Purpose of reviewThe World Health Organization recommends Pre-Exposure Prophylaxis (PrEP) in populations at substantial risk of HIV. Despite a number of randomized controlled trials demonstrating its efficacy, and several ongoing implementation projects, PrEP is currently only available in a few countries.Modelling studies can provide useful insights into the long term impact of introducing PrEP in different subgroups of the population. This review summarizes studies that either evaluated the cost-effectiveness or the cost of introducing PrEP, focusing on seven published in the last year. Recent findingsThese studies used a number of different types of models and investigated the introduction of PrEP in different settings. Among men having sex with men in North America, PrEP ranged from being cost-saving (while benefiting population health) to costing $160,000/quality-adjusted life-year gained. Among heterosexual sero-different couples it varied from around $5,000 to $10,000/disability-adjusted life-year averted, when PrEP was used until six or twelve months after the HIV positive partner had initiated ART in, respectively, Uganda and South Africa. SummaryFuture cost-effectiveness studies of PrEP should consider the HIV incidence, the level of uptake, the effect of its introduction on alternative prevention approaches and the budget impact of rolling it out.

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Cost Effectiveness of ‘On Demand’ Hiv Pre-Exposure Prophylaxis for Non-Injection Drug-Using Men Who Have Sex with Men in Canada

Cited by 43 publications

References 32 publications

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

Impact of the Centers for Disease Control's HIV Preexposure Prophylaxis Guidelines for Men Who Have Sex With Men in the United States

What do we know about the cost–effectiveness of HIV preexposure prophylaxis, and is it affordable?

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