This article is more than 5 years old. Information may no longer be current.

PrEP not cost-effective for people who inject drugs

Recent findings published in the Annals of Internal Medicine showed that use of pre-exposure prophylaxis among people who inject drugs, is not cost-effective.

“The value of [pre-exposure prophylaxis (PrEP)] is maximal when PrEP is delivered with frequent HIV screening and enhanced [antiretroviral therapy (ART)] provision for those who become infected,” Cora L. Bernard, MS, predoctoral student in management science and engineering at Stanford University, and colleagues wrote. “Nonetheless, PrEP [with screening and ART] is an expensive intervention at current prices ... costing $253,000 per [quality-adjusted life-year (QALY)] gained, well above generally accepted thresholds for cost-effectiveness.”

Cora Bernard

Although only 1% of the United States population is composed of people who inject drugs, this group represents 10% of new HIV infections, the researchers wrote. In this group, PrEP has been shown to reduce HIV infections by 49%. However, treatment costs $10,000 annually.

To determine the cost-effectiveness of PrEP for people who inject drugs, the researchers developed a model assessing PrEP alone, PrEP with frequent screening (PrEP+screen) and PrEP with screening and ART for those who become infected (PrEP+screen+ART). In each scenario, they assumed that 25% of all people who inject drugs would be covered and that PrEP would reduce transmission by 49%. They measured the number of infections and deaths averted, change in HIV prevalence, discounted costs, discounted QALYs and incremental cost-effective ratios. In addition, they performed a sensitivity analysis.

They found that PrEP+screen+ART was more effective at reducing HIV compared with the other two strategies. Over 20 years, the program prevented 26,700 infections and reduced HIV prevalence among people who inject drugs by 14% when compared with no program. However, the program costs $253,000 per QALY gained and could cost as much as $44 billion over 20 years. In the sensitivity analysis, the program’s cost-effectiveness was dependent on PrEP adherence, community HIV prevalence and individual transmission risk.

“The study is important because now, with rising levels of opioid drug use in the U.S. and the associated public health risks, it is increasingly important to invest in prevention programs for people who inject drugs that are both effective and cost-effective,” Bernard told Healio Internal Medicine. “We wanted to assess the total population benefits and costs of PrEP for people who inject drugs to inform policy makers about the optimal delivery conditions as well as budget implications of such a program.” – by Will Offit

Disclosures: Bernard reports grants from National Science Foundation and Stanford University PACCAR Inc. Please see the full study for a list of all other authors’ relevant financial disclosures.