Table 3.
LA-PrEP Strategy | Lifetime Risk of HIV Infection,a Infections/1000 High-Risk Women | 5-y Averted HIV-Related Deaths, No./1000 High-risk Womenb |
Discounted Per-Person Lifetime Cost,c $ | PrEP Cost, % of Total Cost | Discounted PrEP Cost per Lifetime HIV Infection Averted,c $ | ICER, $/Life-Year Saved |
||
---|---|---|---|---|---|---|---|---|
Versus No PrEP | Versus Std-PrEP | Versus No PrEP | Versus Std-PrEP | |||||
Base cased | 510 | 16 | 1 | 5300 | 28 | 12 400 | Cost savinge | 150 |
Effectiveness, % | ||||||||
65 | 530 | 15 | 0 | 5660 | 26 | 14 200 | Cost saving | 18 560 |
85 | 490 | 17 | 2 | 4920 | 31 | 10 800 | Cost saving | Cost saving |
95 | 470 | 18 | 3 | 4530 | 34 | 9600 | Cost saving | Cost saving |
HIV infection annual incidence until age 25 y, % | ||||||||
2.5 | 490 | 8 | 0 | 4830 | 32 | 21 800 | 680 | 4790 |
9.0 | 550 | 27 | 2 | 6000 | 24 | 8200 | Cost saving | Cost saving |
PrEP through age | ||||||||
19 y | 600 | 8 | 0 | 5640 | 8 | 15 800 | Cost saving | 590 |
35 y | 430 | 16 | 1 | 5840 | 48 | 14 100 | 60 | 1770 |
45 y | 340 | 16 | 1 | 6240 | 60 | 13 000 | 280 | 2 490 |
Program cost, % of basecase | ||||||||
50 ($9/mo) | 510 | 16 | 1 | 4540 | 16 | 6200 | Cost saving | Cost saving |
150 ($28/mo) | 510 | 16 | 1 | 6040 | 37 | 18 400 | 280 | 7870 |
Scenario | ||||||||
Optimistic (85% efficacy, 50% cost, 9.0% incidence) | 520 | 29 | 4 | 4620 | 16 | 3600 | Cost saving | Cost saving |
Pessimistic (65% efficacy, 150% cost, 2.5% incidence) | 500 | 8 | 0 | 5780 | 39 | 37 500 | 2420 | 165 360 |
Abbreviations: HIV, human immunodeficiency virus; ICER, incremental cost-effectiveness ratio; LA-PrEP, long-acting preexposure prophylaxis; PrEP, preexposure prophylaxis; Std-PrEP, standard preexposure prophylaxis.
a Lifetime HIV infection risk was projected from the cohort starting mean age of 18 years.
b Averted deaths were rounded down to the nearest integer.
c Costs were measured in 2014 $.
d The base case used LA-PrEP with an effectiveness of 75% in a population of women with 5.0% annual HIV infection incidence at a monthly cost of $18.60. PrEP was provided through age 25 y.
e PrEP was more effective and less expensive than the comparator strategy.