Table 1.
Benefits and costs of expanding PrEP coverage and earlier ART strategies over 20 years
| Strategy | Total new Infectionsa | Total infections prevented (fraction)a | New infections with drug-resistant strainsa | Drug-resistant infections prevented (fraction)a | HIV prevalence in 2038 (%) | Total costs of PrEP (million US $)b,c | Total costs (million US $)c | Total QALYsc | Incremental costs (million US $)d | Incremental QALYsd | ICER relative to the status quo | ICER relative to next best strategy |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Status quo (Low PrEP coverage) | 44,508 | – | 18,426 | – | 9.26 | 5648 | 9189 | 1,315,057 | – | – | – | – |
| Medium PrEP coverage | 30,710 | 13,798 (31%) | 14,685 | 3741 (20%) | 5.67 | 11,577 | 14,666 | 1,361,814 | 5477 | 46,757 | 117,130 | Dominatede |
| High PrEP coverage | 21,370 | 23,138 (52%) | 11,487 | 6939 (38%) | 3.81 | 18,056 | 20,773 | 1,402,468 | 11,584 | 87,411 | 132,520 | Dominatede |
| Low PrEP coverage+Earlier ART | 34,808 | 9700 (22%) | 16,969 | 1457 (8%) | 7.43 | 5914 | 9396 | 1,358,706 | 207 | 43,649 | 4745 | 4745 |
| Medium PrEP coverage+Earlier ART | 25,892 | 18,616 (42%) | 13,686 | 4740 (26%) | 5.14 | 11,905 | 15,025 | 1,389,105 | 5836 | 74,048 | 78,811 | 185,160 |
| High PrEP coverage+Earlier ART | 19,093 | 25,414 (57%) | 10,867 | 7559 (41%) | 3.74 | 18,307 | 21,098 | 1,418,327 | 11,909 | 103,270 | 115,320 | 207,830 |
PrEP pre-exposure prophylaxis, ART antiretroviral therapy, ICER incremental cost-effectiveness ratio, QALY quality-adjusted life-year
aTotal new infections, new drug-resistant infections, total HIV infections prevented and drug-resistant infections prevented are undiscounted number from 2018 to 2038
bIncludes the costs of antiretroviral drugs for PrEP, laboratory fees (such as HIV antibody test fee every 2–3 months, test fee for sexually transmitted infections every 6 months) and professional fees (such as visiting and consulting fees) [54]
cCosts and quality-adjusted life years (QALYs) are net present values (3% annual discount rate) over 20 years
dIncremental costs and QALYs are relative to the status quo
eThe strategy that is dominated yields fewer QALYs at higher costs than the comparator and thus is not an effcient use of resources