Preexposure Chemoprophylaxis Cuts HIV Infection at a Cost
(HealthDay News) – Models show daily oral preexposure chemoprophylaxis (PrEP) in the general population of men who have sex with men (MSM) could prevent a substantial number of HIV infections, but at a high cost.
To investigate the effectiveness and cost-effectiveness of PrEP in MSM, Jessie L. Juusola, from Stanford University in Palo Alto, CA, and colleagues used published literature to create a dynamic model of HIV transmission and progression in MSM (aged 13–64 years). Based on clinical trial results, PrEP was assumed to reduce the infection risk by 44%.
The researchers found that utilizing PrEP in 20% of US MSM would reduce new HIV infections by an estimated 13%, resulting in a gain of 550,166 quality-adjusted life-years (QALYs) over 20 years. The estimated cost would be $172,091 per QALY gained. Use of PrEP in a larger proportion of MSM would prevent more infection at a greater cost, up to $216,480 per QALY gained if initiated in all MSM. PrEP costs would probably be about $50,000 per QALY gained for high-risk MSM (average of five partners per year). Costs for using PrEP for 20 years in all high-risk MSM would be $75 billion in added health care-related costs and $600,000 per HIV infection prevented, compared with incremental costs of $95 billion and $2 million per infection prevented with coverage of 20% of all MSM.
"Use in high-risk MSM compares favorably with other interventions that are considered cost-effective but could result in annual PrEP expenditures of more than $4 billion," the authors write.