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PrEP cost-effective in discordant, regular MSM partnerships
Although targeting HIV-negative men in a discordant, same-sex regular partnership for pre-exposure prophylaxis appears to be cost-effective, it would not have a large population-level impact, according to study results published in Clinical Infectious Diseases.
Other scenarios, such as targeting the entire MSM population, were not cost-effective. The cost for PrEP with tenofovir/emtricitabine (Truvada, Gilead), targeting 10% to 30% of the entire MSM population in New South Wales, Australia, would be more than $400,000 (Australian dollars) per quality-adjusted life year gained (QALYG), the researchers reported.
“There has been enthusiasm surrounding the potential for HIV prevention with PrEP,” David Wilson, MD, associate professor at The Kirby Institute for Infection and Immunity in Society at the University of New South Wales in Sydney, Australia, told Infectious Disease News. “Unfortunately, we found that PrEP is currently too expensive and not likely to be effective enough to be a good value for money in high-income countries.”
David Wilson
Wilson and colleagues developed a model of HIV transmission and progression to estimate the clinical outcomes and cost of several PrEP strategies for MSM in New South Wales, Australia. They reported their findings as incremental cost-effectiveness ratios (ICERs) in Australian dollars per QALYG.
Targeting 30% of the entire MSM population would result in a 30.1% reduction in HIV incidence over 10 years, but with a cost of $316 million to $952 million over 10 years. This amounts to $400,000 per QALYG. If MSM with more than 10 partners and MSM with more than 50 partners over a 6 month period were targeted, the cost would be $31 million to $331 million over 10 years, amounting to more than $110,000 per QALYG.
The most cost-effective use of PrEP was among HIV-negative MSM who are in a discordant, regular partnership. The cost of providing PrEP to 15% to 30% of this population ranged from $4.4 million to $12.3 million over 10 years. With 15% coverage, the cost would be $8,399 per QALYG, and with 30% coverage, the cost would be $11,575 per QALYG.
“The results show that PrEP should not be used widely, and is only potentially cost-effective for certain people, primarily HIV-negative MSM in discordant couples where the HIV-positive individual does not take antiretroviral therapy and the couple do not use condoms,” Wilson said. “PrEP could be used more broadly only if drug companies would be willing to reduce the price of the drugs.”
Wilson also said that the effectiveness of PrEP depends on adherence to the drug regimen, and future research should attempt to measure how adherent people will be in the real world. – by Emily Shafer
David Wilson, MD, can be reached at: The Kirby Institute, Centre for Immunology Building, Corner of West and Boundary Streets, Darlinghurst, Sydney NWS 2010, Australia; email: dwilson@unsw.edu.au.
Disclosure: The researchers report no relevant disclosures.