Table 2.
Health and budget impact and maximum price threshold for lenacapavir scale-up
|
Main scenario |
Higher lenacapavir coverage scenario |
|||||
|---|---|---|---|---|---|---|
| Western Kenya | Zimbabwe | South Africa | Western Kenya | Zimbabwe | South Africa | |
| Lenacapavir coverage | 2·9% (2·8 to 3·0) | 4·0% (3·4 to 5·1) | 1·6% (1·5 to 1·8) | 5·8% (5·6 to 6·0) | 8·1% (6·8 to 10·5) | 3·2% (2·9 to 3·6) |
| HIV infections averted | 18·0% (11·0 to 22·9) | 17·0% (3·3 to 28·2) | 12·3% (5·4 to 19·5) | 33·3% (28·5 to 36·9) | 31·0% (21·3 to 45·8) | 21·2% (14·7 to 28·5) |
| HIV-associated deaths averted | 3·5% (0·1 to 6·6) | 5·8 (−3·2 to 14·3) | 3·0% (−0·7 to 6·8) | 6·7% (3·1 to 10·1) | 10·6% (1·6 to 19·3) | 4·9% (0·8 to 8·8) |
| Doses required over the first 5 years | 145 454 (139 757 to 151 137) | 501 406 (421 531 to 645 223) | 3 942 509 (3 541 901 to 4 408 477) | 286 776 (275 591 to 298 169) | 998 447 (833 636 to 1 309 415) | 7 728 013 (6 915 810 to 8 677 953) |
| HIV infections averted per 1000 doses | 29 (17 to 40) | 34 (6 to 74) | 28 (11 to 46) | 27 (22 to 32) | 31 (15 to 57) | 24 (16 to 36) |
| DALYs averted | 45 315 (73 231 to 22 453) | 282 649 (−12 843 to 833 338) | 1 324 790 (−79 790 to 2 908 432) | 83 650 (113 843 to 60 873) | 509 733 (1 044 646 to 135 655) | 2 176 579 (4 055 428 to 697 331) |
| Maximum price per dose at $500 per DALY averted, $ | 16·58 (15·44 to 17·70) | 21·15 (17·70 to 24·89) | 106·28 (95·72 to 115·87) | 14·78 (14·33 to 15·30) | 17·71 (15·61 to 20·05) | 88·34 (83·02 to 94·19) |
| Maximum price per dose at $200 per DALY averted, $ | 11·32 (10·34 to 12·23) | 11·68 (9·09 to 14·21) | 74·87 (66·65 to 82·33) | 9·87 (9·38 to 10·31) | 9·23 (7·73 to 10·77) | 62·34 (58·18 to 66·88) |
| 5-year budget impact, $ | 4 086 333 (3 863 089 to 4 297 703) | 16 803 502 (13 951 046 to 22 639 690) | 507 252 479 (436 138 529 to 585 420 059) | 7 451 884 (7 110 730 to 7 845 199) | 29 500 374 (24 615 177 to 39 523 839) | 835 292 422 (736 980 200 to 962 975 488) |
| Modelled population size in 2026 | 4 299 746 (4 291 296 to 4 310 059) | 10 683 464 (10 621 909 to 10 754 812) | 41 792 955 (41 519 588 to 42 030 162) | 4 299 746 (4 291 296 to 4 310 059) | 10 683 464 (10 621 909 to 10 754 812) | 41 792 955 (41 519 588 to 42 030 162) |
Health impacts are compared to the baseline scenario of daily oral pre-exposure prophylaxis only. HIV infections averted are reported for people aged 15–65 years over 10 years of lenacapavir implementation; deaths averted are calculated over the 35-year time horizon. Lenacapavir coverage is reported for people aged 15–49 years over 10 years of lenacapavir implementation. Prices are in 2021 US$. Values in parentheses show 95% uncertainty intervals representing the 2·5th and 97·5th percentiles across 100 parameter sets. DALYs=disability-adjusted life-years.