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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

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).