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Cost–effectiveness of pre-exposure prophylaxis for HIV: a review

Schackman, Bruce R.; Eggman, Ashley A.

doi: 10.1097/COH.0b013e3283582c8b
PRE-EXPOSURE PROPHYLAXIS: Edited by Kenneth H Mayer

Purpose of review: The US Food and Drug Administration (FDA) recently approved the use of tenofovir–emtricitabine for pre-exposure prophylaxis (PrEP) for HIV prevention. PrEP is also being investigated in clinical trials as a component of HIV prevention in resource-limited settings. Cost–effectiveness models are useful in identifying health programs with the greatest societal value and projecting long-term program impacts. This review examines six recent studies of the cost–effectiveness of PrEP for preventing HIV transmission in the USA and South Africa.

Recent findings: Studies used both individual-level and population-level transmission models. PrEP was found to be a cost-effective HIV-prevention intervention in high-risk MSM with HIV incidence at least 2% in the USA (<US$100 000 per quality-adjusted life year) and in young women in South Africa (cost per life year <GDP per capita). Results were sensitive to the cost and efficacy of PrEP and to assumptions about HIV testing and access to treatment in the absence of PrEP.

Summary: Future cost effectiveness studies should consider PrEP implementation issues (uptake in high-risk versus low-risk groups, duration on PrEP, adherence), budget impact, and the role of PrEP as part of combination HIV-prevention strategies including expanded testing and treatment access.

Weill Cornell Medical College, New York, New York, USA

Correspondence to Bruce R. Schackman, PhD, Associate Professor, Department of Public Health, Weill Cornell Medical College, 402 E. 67th Street, New York, NY 10065, USA. Tel: +1 646 962 8043; fax: +1 646 962 0281; e-mail: brs2006@med.cornell.edu

An earlier version of this review was presented on 12 June 2012 at the TasP and PrEP Evidence Summit ‘Controlling the HIV Pandemic with Antiretrovirals: Treatment as Prevention and Pre-Exposure Prophylaxis’ in London, UK.

© 2012 Lippincott Williams & Wilkins, Inc.