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. Author manuscript; available in PMC: 2013 Jun 24.
Published in final edited form as: Ann Intern Med. 2012 Apr 17;156(8):541–550. doi: 10.1059/0003-4819-156-8-201204170-00001

Figure 2. Cost-Effectiveness of PrEP for HIV Prevention as a Function of PrEP Efficacy and Cost.

Figure 2

(a) This two-way sensitivity analysis shows ranges of the incremental cost-effectiveness ratio for initiating 20% of the general MSM population on PrEP as a function of PrEP efficacy and cost. Costs depicted on the vertical axis are annual and include all ARV and monitoring costs. The horizontal axis denotes PrEP efficacy, measured as the percentage reduction in the probability of an uninfected individual acquiring HIV infection from an infected individual. The color at each point signifies the incremental cost-effectiveness ratio for that PrEP efficacy and cost. For example, the incremental cost-effectiveness ratio is less than $100,000/quality-adjusted life year (QALY) gained when PrEP efficacy is greater than 75% or when efficacy is at least 40% and costs are less than $5,427 per year. Incremental costs and QALYs used to calculate the incremental cost-effectiveness ratios are calculated over a 20-year time horizon and are discounted to the present at 3% annually.

(b) This two-way sensitivity analysis shows ranges of the incremental cost-effectiveness ratio for initiating all high-risk MSM on PrEP as a function of PrEP efficacy and cost. Costs depicted on the vertical axis are annual and include all ARV and monitoring costs. The horizontal axis denotes PrEP efficacy, measured as the percentage reduction in the probability of an uninfected individual acquiring HIV infection from an infected individual. The color at each point signifies the incremental cost-effectiveness ratio for that PrEP efficacy and cost. For example, at our base-case cost, the incremental cost-effectiveness ratio is less than $100,000/QALY gained as long as PrEP efficacy is greater than 22%. Incremental costs and QALYs used to calculate the incremental cost-effectiveness ratios are calculated over a 20-year time horizon and are discounted to the present at 3% annually.

Note: PrEP = preexposure prophylaxis, MSM = men who have sex with men, ICER = incremental cost-effectiveness ratio.