September 20, 2016
Compared with currently used strategies, pre-exposure prophylaxis (PrEP) and test-and-treat strategies are highly cost-effective methods for preventing the spread of HIV among men who have sex with men (MSM), according to a study in the online Clinical Infectious Diseases.
Researchers came to their findings after using a mathematical epidemiologic model to simulate HIV incidence among MSM in Los Angeles County. Combining incidence data with an economic model, they estimated and compared the cost-effectiveness of various HIV prevention strategies, including PrEP for men at high risk of infection, test-and-treat (expanded HIV testing combined with immediate initiation of antiretroviral treatment), and the status quo of testing with treatment initiation for patients with CD4 ≤ 500 cells/μL.
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Testing every 4 years with immediate initiation of treatment, researchers found, was the most cost-effective strategy at $19,302 per quality-adjusted life-year. At its most cost-effective, PrEP for MSM at highest risk of HIV in addition to a test-and-treat strategy would cost $27,863 per quality-adjusted life year.
According to the model, the status quo approach would result in a 99,874 new cases of HIV. Test-and-treat would avert 4332, or 4.3%, of the cases, while PrEP would prevent 58,881, or 59%, of them
“With constrained budgets, test-and-treat is the optimal policy, and with less constrained budgets, test-and-treat combined with PrEP is the optimal policy,” Emmanuel F Drabo, PhD, of the department of pharmaceutical and health economics at the school of pharmacy at the University of Southern California, and colleagues wrote. “Overall, these results help policymakers and public health officials choose the optimal HIV prevention strategy given their budget constraints.”
In a related editorial, Kenneth H Mayer and Douglas S Krakower of the Fenway Institute and Harvard Medical School agreed that the study would help guide policymakers and public health authorities in thinking through the best strategies for controlling the HIV epidemic.
“Although antiretrovirals are not a panacea,” they wrote, “their judicious use in a comprehensive program that addresses the full medical and behavioral health needs of those who are HIV-infected or affected can contribute to a net result that will halt the further spread of HIV.”—Jolynn Tumolo
1.Drabo EF, Hay JW, Vardavas R, Wagner ZR, Sood N. A cost-effectiveness analysis of pre-exposure prophylaxis for the prevention of HIV among Los Angeles County men who have sex with men. Clinical Infectious Diseases. 2016 August 23. [Epub ahead of print].