PS2-4
COST-EFFECTIVENESS OF HIV PREEXPOSURE PROPHYLAXIS FOR INJECTION DRUG USERS IN THE UNITED STATES
Method: We developed a dynamic transmission model of the US HIV epidemic to evaluate the costs and benefits of oral PrEP for IDUs, combining new trial results with epidemiological and economic data. We projected impacts on monthly HIV prevalence and incidence for IDUs, men who have sex with men and lower risk groups under a variety of adherence and efficacy, cost, transmission risk, and delivery scenarios. Finally, we estimated the incremental cost per quality-adjusted life year (QALY) gained.
Result: Compared to the status quo, introducing PrEP for 50% of uninfected IDUs averts 66,000 infections in total and reduces HIV prevalence among IDUs by 36% (from 6.1% to 3.9%) over 20 years. Despite these health benefits, the high price of PrEP results in an incremental cost-effectiveness ratio of $214,000 per QALY gained. If its current price were halved, then PrEP for IDUs would cost approximately $100,000 per QALY gained. At its current price, we estimate that the net intervention costs of PrEP could be as high as $88 billion over 20 years. Scenario analyses show that PrEP is most valuable when combined with frequent HIV screening and access to antiretroviral treatment should an individual become infected. PrEP’s value increases in regions of high HIV incidence and prevalence among IDUs and depends greatly on adherence levels and drug efficacy.
Conclusion: PrEP for IDUs can provide substantial health benefits but is an expensive intervention at current drug prices.