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.