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What do we know about the cost–effectiveness of HIV preexposure prophylaxis, and is it affordable?

Cambiano, Valentinaa; Miners, Alecb; Phillips, Andrewa

Current Opinion in HIV and AIDS: January 2016 - Volume 11 - Issue 1 - p 56–66
doi: 10.1097/COH.0000000000000217
THE PREP REVOLUTION: FROM CLINICAL TRIALS TO ROUTINE PRACTICE: Edited by Jared Baeten Sheena McCormack
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Purpose of review The WHO recommends preexposure prophylaxis (PrEP) in populations at substantial risk of HIV. Despite a number of randomized controlled trials demonstrating its efficacy, and several ongoing implementation projects, PrEP is currently only available in a few countries. Modelling studies can provide useful insights into the long-term impact of introducing PrEP in different subgroups of the population. The review summarizes studies that either evaluated the cost–effectiveness or the cost of introducing PrEP, focusing on seven published in the last year.

Recent findings These studies used a number of different types of models and investigated the introduction of PrEP in different settings. Among men having sex with men (MSM) in North America, PrEP ranged from being cost-saving (while benefiting population health) to costing US $160 000/quality-adjusted life-year gained. Among heterosexual sero-different couples, it varied from around US $5000 to US $10 000/disability-adjusted life-year averted, when PrEP was used until 6 or 12 months after the HIV-positive partner had initiated antiretroviral therapy (ART) in, respectively, Uganda and South Africa.

Summary Future cost–effectiveness studies of PrEP should consider the HIV incidence, the level of uptake, the effect of its introduction on alternative prevention approaches, and the budget impact of rolling it out.

aResearch Department of Infection and Population Health, UCL

bDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK

Correspondence to Valentina Cambiano, Research Department of Infection and Population Health, UCL, Rowland Hill Street, London NW3 2PF, UK. Tel: +44 207 794 0500 x34570; e-mail: v.cambiano@ucl.ac.uk

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.