Preexposure Chemoprophylaxis Cuts HIV Infection at a Cost

Targeted prophylaxis strategy most cost-effective in highest risk men who have sex with men

TUESDAY, April 17 (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, according to a study published in the April 17 issue of the Annals of Internal Medicine.

To investigate the effectiveness and cost-effectiveness of PrEP in MSM, Jessie L. Juusola, from Stanford University in Palo Alto, Calif., and colleagues used published literature to create a dynamic model of HIV transmission and progression in MSM (aged 13 to 64 years). Based on clinical trial results, PrEP was assumed to reduce the infection risk by 44 percent.

The researchers found that utilizing PrEP in 20 percent of U.S. MSM would reduce new HIV infections by an estimated 13 percent, 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 percent 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.

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