Assessing the Cost Effectiveness of Pre-Exposure Prophylaxis for HIV Prevention in the US

• Published in: PharmacoEconomics Vol. 31; no. 12; pp. 1091 - 1104
• Main Author: Hellinger, Fred J.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-12-2013; Adis International; Springer; Springer Nature B.V
• Subjects: AIDS vaccines; Anti-HIV agents; Anti-Retroviral Agents - administration & dosage; Anti-Retroviral Agents - economics; Anti-Retroviral Agents - therapeutic use; Antiretroviral drugs; Antiviral agents; Biological and medical sciences; Chemoprevention - economics; Chemoprevention - methods; Clinical trials; Condoms; Cost analysis; Cost-Benefit Analysis; Current Opinion; Disease prevention; Disease transmission; Dosage and administration; Drug therapy; Economic aspects; Health Administration; Health care expenditures; Health Economics; Health technology assessment; HIV; HIV Infections - economics; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Infections - transmission; Human immunodeficiency virus; Human viral diseases; Humans; Illnesses; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Incidence; Infectious diseases; Malaria; Medical economics; Medical sciences; Medicine; Medicine & Public Health; Monte Carlo Method; Pharmacoeconomics and Health Outcomes; Prevalence; Prevention and actions; Primary care; Prophylaxis; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life Research; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Sexual Behavior; Sexually transmitted diseases; Specific populations (family, woman, child, elderly...); STD; Studies; Tuberculosis; United States - epidemiology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; United States; North America; America; United States > US; Human; Immunopathology; Evaluation; Sanitary program; Retroviridae; AIDS; Immune deficiency; Lentivirus; Infection; Virus; Prevention; Viral disease; Health economy; Human immunodeficiency virus; Public health; Cost efficiency analysis
• ISSN: 1170-7690; 1179-2027
• DOI: 10.1007/s40273-013-0111-0

About 50,000 people are infected with HIV in the US each year and this number has remained virtually the same for the past decade. Yet, in the last few years, evidence from several multinational randomized clinical trials has shown that the provision of antiretroviral drug to uninfected persons (i.e. pre-exposure prophylaxis) reduces the incidence of HIV by about 50 %. However, evidence from cost-effectiveness studies conducted in the US yield widely varying estimates of the cost per quality-adjusted life-year (QALY) gained, and this variation reflects the substantial uncertainty surrounding the determinants of HIV transmission (e.g. adherence rates to prophylactic medications, the average number of sexual partners, the number and types of sexual acts, the viral load of infected partners, and the proportion of contacts where condoms are used), as well as different approaches to translating a reduction in HIV cases into an estimate of the increase in the number of QALYs.