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Nationwide PREP Implementation Would Be Cost-Effective

October 25, 2017

Recent research in Lancet Infectious Diseases found that nationwide rollout of providing pre-exposure prophylaxis (PREP), an HIV prevention drug, would be cost effective in England.

“In the United Kingdom, HIV incidence among men who have sex with men has remained high for several years, despite widespread use of antiretroviral therapy and high rates of virological suppression,” Valentina Cambiano, PhD, of the Institute for Global Health at the University College London, and colleagues wrote. “PREP has been shown to be highly effective in preventing further infections in men who have sex with men, but its cost-effectiveness is uncertain.”

The researchers developed a model to study the economic impact of widespread PREP utilization using data from a nationally representative survey of men who have sex with men in the United Kingdom. They then measured the number of men who had negative HIV tests in the preceding year, negative HIV test at baseline, and high-risk intercourse within 3 months of baseline. These data were used to determine a model of HIV infection risk, quality-adjusted life years (QALY), and costs.

Study results showed that if a program were implemented that initiated PREP in 4000 high-risk patients during year 1 and 40,000 high risk patients by year 15, then cost savings would total over £1 billion and prevent 25% of HIV cases. This program would also increase QALYs by 40,000 over 80 years.

“There is no doubt about the effectiveness of PrEP. In addition to delivering a substantial health benefit, our work suggests that introduction of PrEP will ultimately lead to a saving in costs, as a result of decreased numbers of men in need of lifelong HIV treatment,” Dr Cambiano said in a press release.

The researchers added that costs for PREP could come down over the next few years as patents expire—which would further increase the cost-effectiveness of widespread PREP use.

“As antiretroviral drug patents expire over the next few years, the emergence of generic drugs could result in large cost reductions for PrEP, and these reductions could help to limit the impact of PrEP on NHS budgets, making it cost-effective over a relatively short time,” co-author Alison Rodger, PhD, BSc, of the University of Warwick, concluded in a press release.

David Costill

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