OBJECTIVES: A 2010 randomized controlled trial, the first in the United States (US), was carried out to study the clinical effectiveness of pre-exposure HIV prophylaxis (PrEP) among men-who-have-sex-with-men (MSM) population over a follow up of three years (iPREX trial). The study objective was to estimate the cost-effectiveness of PrEP (Emtricitabine-Tenofovir combination pill) from the US payer perspective using both short-run and long-run outcomes. METHODS: We designed a decision analytical model using Excel® 2013 that mimicked the iPREX trial environment to compare costs and outcomes of PrEP plus usual care versus usual care alone (i.e. condom use). Outcomes included HIV cases averted over the trial period of 3 years and life years gained (LYG) over a lifetime time horizon. Since the adherence of PrEP was an important outcome measure in the trial, we factored in the PrEP adherence relationship of HIV acquisition into the model. Condom effectiveness was defined as probability of remaining HIV negative, assuming consistent condom usage. All costs were adjusted to 2014. RESULTS: From our base-case analysis, the treatment arm (PrEP plus usual care) resulted in an incremental cost of $ 1,369,784 per HIV case averted over a 3-year time frame and an incremental cost of $ 34,973.50 per LYG over a lifetime time horizon. Our one-way sensitivity analysis suggested that condom effectiveness below 92% can make PrEP to be cost-saving per LYG. Our probabilistic sensitivity analysis suggested that the cost-effectiveness probability of PrEP is at least 50% if the payer is willing to pay a minimum of $45,000-$50,000 per LYG. CONCLUSIONS: The short-run value of PrEP from the US payer perspective may be greater than their willingness-topay. Further research is warranted to understand subgroups where PrEP value differs as well as payers' willingness-to-pay for HIV-specific and generic health outcomes.
Vaidya, N., & Campbell, J. D. (2015). A Cost-Effectiveness analysis of Pre-Exposure Prophylaxis for Hiv: a Us Payer Perspective. Value in Health, 18(3), A236–A237. https://doi.org/10.1016/j.jval.2015.03.1376