Table 3.

Pre-Exposure Prophylaxis and Treatment as Prevention Strategies

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.

¹The asterisk (*) next to YEAR USD indicates year of article publication when year of USD is not reported in the article.