The Cost and Impact of Scaling Up Pre-exposure Prophylaxis for HIV Prevention: A Systematic Review of Cost-Effectiveness Modelling Studies

Gomez, Gabriela B.; Bórquez, Annick; Case, Kelsey K.; Wheelock, Ana; Vassall, Anna; Hankins, Catherine

doi:10.1371/journal.pmed.1001401

Cited by 191 publications

(159 citation statements)

References 37 publications

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“…In this context, a systematic review 76 of the studies that estimated the impact and cost of PrEP on the epidemic showed that the offer of prophylaxis may have a significant impact on the reduction of incidence and be cost-effective, especially if people with higher risk were to be prioritized. In concentrated epidemics 77,78 , even in a scenario of amplification of TasP and moderate changes in sexual practices, the impact of PrEP would be significant, even though the authors warn us that the sensitivity analyses indicated that an unlikely increase in large-scale risk practices would lead to increasing incidence 78 .…”

Section: Prevention For People Who Are More Exposed and Do Not Want Tmentioning

confidence: 99%

The effect of prevention methods on reducing sexual risk for HIV and their potential impact on a large-scale: a literature review

Grangeiro

Ferraz

Calazans

et al. 2015

Rev. bras. epidemiol.

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A spectrum of diverse prevention methods that offer high protection against HIV has posed the following challenge: how can national AIDS policies with high coverage for prevention and treatment make the best use of new methods so as to reverse the current high, and even rising, incidence rates among specific social groups? We conducted a narrative review of the literature to examine the prevention methods and the structural interventions that can have a higher impact on incidence rates in the context of socially and geographically concentrated epidemics. Evidence on the protective effect of the methods against sexual exposure to HIV, as well as their limits and potential, is discussed. The availability and effectiveness of prevention methods have been hindered by structural and psychosocial barriers such as obstacles to adherence, inconsistent use over time, or only when individuals perceive themselves at higher risk. The most affected individuals and social groups have presented limited or absence of use of methods as this is moderated by values, prevention needs, and life circumstances. As a result, a substantial impact on the epidemic cannot be achieved by one method alone. Programs based on the complementarity of methods, the psychosocial aspects affecting their use and the mitigation of structural barriers may have the highest impact on incidence rates, especially if participation and community mobilization are part of their planning and implementation.

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Section: Prevention For People Who Are More Exposed and Do Not Want Tmentioning

confidence: 99%

The effect of prevention methods on reducing sexual risk for HIV and their potential impact on a large-scale: a literature review

Grangeiro

Ferraz

Calazans

et al. 2015

Rev. bras. epidemiol.

View full text Add to dashboard Cite

show abstract

“…10 However, it is not always clear what priority these concerns receive in programmes over other considerations such as achieving scale or rolling out new interventions. Finally, new interventions or additions to health programmes have typically been evaluated in isolation [11][12][13] and held in comparison to an estimate of the cost-effectiveness of interventions already funded, an approach that ignores the relative costs and impacts of alternative options. Exceptions in Africa include a national-level cost-effectiveness analysis of prevention portfolios 14 and an exploration of combination prevention in a hyperendemic setting.…”

Section: Introductionmentioning

confidence: 99%

Optimum resource allocation to reduce HIV incidence across sub-Saharan Africa: a mathematical modelling study

et al. 2016

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“…Previous economic evaluations have separately examined the cost-effectiveness of PrEP or HIV vaccines in the US, but none have modeled the potential outcomes when combining these products [18][19][20][21][22][23], as shown in a recent review of HIV vaccine cost-effectiveness studies [24]. For treatment of HIV, Truvada® is highly cost-effective when used in combination with other drugs, but the costeffectiveness estimates for prevention are mixed in reviews [21,25,26].…”

Section: Introductionmentioning

confidence: 99%

“…For treatment of HIV, Truvada® is highly cost-effective when used in combination with other drugs, but the costeffectiveness estimates for prevention are mixed in reviews [21,25,26]. If an HIV vaccine is launched in the US, experts may consider modifying PrEP clinical guidelines to inform the most efficient use in combination with HIV vaccines [27].…”

Section: Introductionmentioning

confidence: 99%

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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The Cost and Impact of Scaling Up Pre-exposure Prophylaxis for HIV Prevention: A Systematic Review of Cost-Effectiveness Modelling Studies

Abstract: Gabriela Gomez and colleagues systematically review cost-effectiveness modeling studies of pre-exposure prophylaxis (PrEP) for preventing HIV transmission and identify the main considerations to address when considering the introduction of PrEP to HIV prevention programs.

Cited by 191 publications

References 37 publications

The effect of prevention methods on reducing sexual risk for HIV and their potential impact on a large-scale: a literature review

The effect of prevention methods on reducing sexual risk for HIV and their potential impact on a large-scale: a literature review

Optimum resource allocation to reduce HIV incidence across sub-Saharan Africa: a mathematical modelling study

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

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