The Cost-Effectiveness of Preexposure Prophylaxis for HIV Prevention in the United States in Men Who Have Sex With Men

Abstract

Agency for Healthcare Research and Quality.

A SWOT Analysis of the Updated National HIV/AIDS Strategy for the U.S., 2015–2020

“…Therefore, to implement PrEP for persons who might benefit one must delve into substantial detail about how to ensure coverage by public sector programs, as well as how to involve the private sector in reducing the drug price and encouraging insurance companies to guarantee coverage. Further, estimates of the cost-effectiveness of this investment would be useful as the published literature on the cost-effectiveness of PrEP varies from study to study largely depending on how PrEP is targeted in its implementation (and cost-effectiveness is key for achieving the maximum public health benefit for a given level of resource) [14][15][16]. Therefore, PrEP is a critical new tool in HIV prevention, but identifying payment strategies and ways to best target PrEP services are key to its most impactful implementation and should be included in the federal action plan to the updated NHAS.…”

Assessing the Cost Effectiveness of Pre-Exposure Prophylaxis for HIV Prevention in the US

“…One reason for this is the variation in the cost of drugs in various countries. For example, Walensky and colleagues [49] estimated the cost of drugs for a tenofovir disoproxil fumarate-based vaginal microbicide was $55 a year per person in South Africa (2010 US$), and Juusola and colleagues [53] estimated the cost of drugs for an oral tenofovir disoproxil fumarate-based pre-exposure prophylaxis program was $15,589 a year per person in the US (2010 US$).…”

“…In particular, Desai and colleagues [50] estimated that the cost per QALY saved for a preexposure prophylaxis program for MSM in the US was $31,970 (2007 US$), and Paltiel and colleagues [48] estimated the cost per QALY saved for a pre-exposure prophylaxis program for MSM in the US was $298,000 (2006 US$). Subsequently, Juusola and colleagues [53] estimated the cost per QALY saved for a pre-exposure prophylaxis program for MSM in the US to be $172,000 (2010 US$).…”

“…For example, Desai and colleagues [50] developed a risk-based HIV transmission model to analyze a 5-year pre-exposure prophylaxis program, while Juusola and colleagues [53] assume that their pre-exposure prophylaxis program was operational for 20 years.…”

“…Juusola and colleagues [53] hypothesized that the efficacy of pre-exposure prophylaxis was 44 % (based on findings from the iPrEx trial) and then calculated the cost effectiveness of a pre-exposure prophylaxis program that treated 20 % of MSM in the US. The authors used a dynamic model of HIV treatment and progression and found that the pre-exposure prophylaxis program reduced the number of new HIV infections by 13 % and increased the number of QALYs by 550,000 at a cost of $172,000 per QALY (2010 US$).…”