Table 2.
Benefits and Costs of PrEP Strategies Over 20 Years – General MSM Population
| ICER Relative to§ | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Strategy* | New HIV Infections¶ |
HIV Infections Prevented† |
HIV Prevalence at 20 Years |
Total Costs of PrEP (billions) ¥# |
Total Costs (billions)¥ |
Total QALYs¥ | Incremental Costs¥‡ (billions) | Incremental QALYs¥‡ | No PrEP | Next Lower Level of PrEP |
| 100% Start PrEP | 242,627 | 249,156 (51%) | 6.4% | $495 | $1,366 | 117,488,043 | $480 | 2,217,732 | $216,480 | $253,645 |
| 50% Start PrEP | 348,492 | 143,291 (29%) | 7.9% | $247 | $1,124 | 116,533,983 | $238 | 1,263,673 | $188,421 | $201,012 |
| 20% Start PrEP | 429,025 | 62,759 (13%) | 9.0% | $98 | $980 | 115,820,477 | $95 | 550,166 | $172,091 | $172,091 |
| Status Quo (No PrEP) | 491,784 | 9.9% | $886 | 115,270,310 | ||||||
PrEP = preexposure prophylaxis.
New HIV infections and HIV infections prevented are undiscounted totals. Discounting infections at 3% annually reduces the number of infections averted for each strategy by approximately 22%.
The values in parentheses are the fraction of total HIV infections prevented.
Costs and quality-adjusted life years (QALYs) are net present values (3% annual discount rate) over 20 years.
Total costs of PrEP include the cost of antiretroviral drugs for PrEP, costs of monitoring tests and physician visits, and initiation and discontinuation costs.
Incremental costs and QALYs are relative to the status quo.
ICER = Incremental cost-effectiveness ratio, relative to the status quo of no PrEP use or the next lower level of PrEP use (i.e., the PrEP use scenario in the row below, with a lower percentage of MSM starting PrEP).