• Ann. Intern. Med. · Jul 2016

    Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States.

    • Cora L Bernard, Margaret L Brandeau, Keith Humphreys, Eran Bendavid, Mark Holodniy, Christopher Weyant, Douglas K Owens, and Jeremy D Goldhaber-Fiebert.
    • Ann. Intern. Med. 2016 Jul 5; 165 (1): 10-19.

    BackgroundThe total population health benefits and costs of HIV preexposure prophylaxis (PrEP) for people who inject drugs (PWID) in the United States are unclear.ObjectiveTo evaluate the cost-effectiveness and optimal delivery conditions of PrEP for PWID.DesignEmpirically calibrated dynamic compartmental model.Data SourcesPublished literature and expert opinion.Target PopulationAdult U.S. PWID.Time Horizon20 years and lifetime.InterventionPrEP alone, PrEP with frequent screening (PrEP+screen), and PrEP+screen with enhanced provision of antiretroviral therapy (ART) for individuals who become infected (PrEP+screen+ART). All scenarios are considered at 25% coverage.Outcome MeasuresInfections averted, deaths averted, change in HIV prevalence, discounted costs (in 2015 U.S. dollars), discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.Results Of Base Case AnalysisPrEP+screen+ART dominates other strategies, averting 26 700 infections and reducing HIV prevalence among PWID by 14% compared with the status quo. Achieving these benefits costs $253 000 per QALY gained. At current drug prices, total expenditures for PrEP+screen+ART could be as high as $44 billion over 20 years.Results Of Sensitivity AnalysisCost-effectiveness of the intervention is linear in the annual cost of PrEP and is dependent on PrEP drug adherence, individual transmission risks, and community HIV prevalence.LimitationData on risk stratification and achievable PrEP efficacy levels for U.S. PWID are limited.ConclusionPrEP with frequent screening and prompt treatment for those who become infected can reduce HIV burden among PWID and provide health benefits for the entire U.S. population, but, at current drug prices, it remains an expensive intervention both in absolute terms and in cost per QALY gained.Primary Funding SourceNational Institute on Drug Abuse.

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