Table 3.
Citation | Model Type | Strategy | Results | ||
---|---|---|---|---|---|
$/Infection Averted |
$/QALY gained or $/DALY averted1 |
Other | |||
Pre-Exposure Prophylaxis | |||||
Evaluating the impact of prioritization of antiretroviral pre-exposure prophylaxis in New York (United States) [42] |
Monte Carlo with deterministic compartmental transmission |
Compare prioritization of PrEP between high risk heterosexuals, high risk MSM, all MSM, IDUs, and all high risk |
Ranges from $1.6 million to $54 million |
Not reported (2012 USD) |
Diminishing returns when PrEP is expanded beyond high risk MSM |
Clinical effectiveness and cost- effectiveness of HIV PrEP in MSM: risk calculators for real- world decision-making (United States) [43] |
Decision- analytic based on decision tree framework |
Estimate the number needed to treat for MSM in various risk, adherence, and behavioral scenarios |
Not reported | $160,000/QALY for PrEP to all MSM in the US (2012 USD) |
Number needed to treat is 64 |
A cost-effectiveness analysis of HIV PrEP for MSM in Australia [44] |
Stochastic agent-based |
Compare PrEP to all MSM, high risk MSM, and serodiscordant MSM to no PrEP |
Not reported | $8,400-11,575 (AUD) /QALY gained to serodiscordant MSM ($7,790-10,740 USD, 2013) |
>$400,000 (AUD)/QALY gained to all MSM (>$371,000 USD) |
Effectiveness and cost- effectiveness of oral PrEP in a portfolio of prevention programs for IDUs in mixed HIV epidemics (Ukraine) [45] |
Dynamic compartmental |
Compare PrEP, ART and/or methadone maintenance therapy (MMT) to no intervention in IDUs |
Not reported | MMT: $520/QALY gained Adding PrEP: $1,700 (2008 USD) |
PrEP becomes as cost- effective as MMT if priced less than $650 and cost-saving is priced less than $370 |
HIV-serodiscordant couples desiring a child: “treatment as prevention,” preexposure prophylaxis, or medically assisted procreation? (France) [46] |
Markov decision tree |
Compare conception strategies: PrEP, TasP, medically assisted procreation |
Not reported | PrEP limited to fertile days: €1.13M (~$1.5M) per life year saved compared to TasP and intercourse limited to fertile days (2013 Euro or USD) |
Medically assisted procreation is €3.6M (~$4M) per life year saved compared to limited PrEP |
Cost-effectiveness of tenofovir gel in urban South Africa: model projections of HIV impact and threshold product prices [47] |
Population-level deterministic compartmental transmission |
Linear scale-up of tenofovir gel to 30% uptake over 10 years; gel used in 72% of sex acts |
Not reported | ICER $297/DALY averted (2012 USD) |
Reduce HIV incidence by 12.5% |
Comparative effectiveness and cost-effectiveness of ART and PrEP for HIV prevention in South Africa [48] |
Dynamic compartmental |
Compare ART scale- up at different initiation thresholds and scale-up; determine additional cost of adding PrEP |
Not reported | Adding targeted PrEP ranges from $160-220/QALY gained (2014 USD*) |
|
Cost-effectiveness of PrEP targeted to high-risk serodiscordant couples as a bridge to sustained ART use in Kampala, Uganda [49] |
Dynamic transmission |
Current ART coverage vs. ART scale-up for CD4<500 vs. PrEP+ART scale-up |
ICER $1,340 (PrEP+ART) |
ICER $5,354 (PrEP+ART) per DALY averted (2012 USD) |
PrEP+ART averts 43% of infections |
Estimating the cost- effectiveness of PrEP to reduce HIV-1 and HSV-2 incidence in HIV-serodiscordant couples in South Africa [50] |
Microsimulation | PrEP to uninfected partner prior to and during 1st year of ART initiation in infected partner |
Not reported | $9,757- 10,383/DALY averted (2015 USD*) |
HSV-2 prevention has little impact on cost- effectiveness |
Seasonal PrEP for partners of migrant miners in southern Mozambique: a highly focused PrEP intervention [51] |
Population-level deterministic transmission |
6 weeks of targeted PrEP each year for partners of miners timed when miners return home from South Africa |
$71,374 for year- long PrEP $9,540 for 6 week period |
Not reported (2012 USD) |
For cost/infection averted to be <$3,000, cost of PrEP would need to decrease and users would need good adherence |
Cost-effectiveness of PrEP in HIV/AIDS control in Zambia: a stochastic league approach [53] |
Deterministic, Monte Carlo |
Compare ART scale- up, prioritized PrEP, and general PrEP |
Not reported | ICER PrEP+ART: $5,861/QALY gained (2012 USD) |
PrEP would require a 10-fold increase in budget |
Treatment as Prevention | |||||
Cost-effectiveness of HIV treatment as prevention in serodiscordant couples (South Africa, India) [57] |
Deterministic, individual-based Markov |
Compare early ART initiation with guideline-concordant ART initiation |
Not reported | South Africa ICER $590/LYS India ICER $530/LYS (2011 USD) |
Results exclude costs of case identification and testing required to indentify participants with high CD4 counts |
Comparative effectiveness and cost-effectiveness of ART and PrEP for HIV prevention in South Africa [48] |
Dynamic compartmental |
Compare ART scale- up at different initiation thresholds and scale-up; determine additional cost of adding PrEP |
Not reported | ICER for ART scale- up ranges from $310- 990/QALY gained (2014 USD*) |
|
Cost-effectiveness of PrEP targeted to high-risk serodiscordant couples as a bridge to sustained ART use in Kampala, Uganda [49] |
Dynamic transmission |
Current ART coverage vs. ART scale-up for CD4<500 vs. PrEP+ART scale-up |
ICER $1,452 (ART alone) |
ICER $1,075 (ART scale-up) per DALY averted (2012 USD) |
ART scale-up averts 37% of infections |
Cost-effectiveness of PrEP in HIV/AIDS control in Zambia: a stochastic league approach [53] |
Deterministic, Monte Carlo |
Compare ART scale- up, prioritized PrEP, and general PrEP |
Not reported | ICER ART scale-up: $62/QALY gained (2012 USD) |
QALY: quality-adjusted life year; DALY: disability-adjusted life year; PrEP: pre-exposure prophylaxis; CAD: Canadian dollars; USD: United States dollars; AUD: Australian dollars; ART: antiretroviral therapy; MSM: men who have sex with men; IDU: injecting drug user; TasP: treatment as prevention; ICER: incremental cost-effectiveness ratio; YLS: year of life saved.
The asterisk (*) next to YEAR USD indicates year of article publication when year of USD is not reported in the article.