Table 1.
Benefits and costs of expanding PrEP coverage from 2022 to 2052.
| Strategy | Total new infections | Total new infections prevented (fraction) | New infections with drug-resistant strains | Drug-resistant infections prevented (fraction) | HIV prevalence in 2052 | Total HIV-related death | Total HIV-related death prevented (fraction) | Total costs (million US $) a,b | Total QALYs b | Increment-al costs (million US $) c | Increment-al QALYs c | ICER relative to the status quo | ICER relative to next best strategy |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| no PrEP + 77% ART (Base case) | 124,639 | .. | 10,812 | .. | 27·8% | 33,884 | .. | 2470 | 9,851,789 | .. | .. | .. | .. |
| 20% PrEP + 77% ART | 81,920 | 42,719 (34·3%) |
9059 | 1753 (16·5%) |
20·6% | 27,973 | 5911 (17·2%) |
6225 | 9,902,777 | 3739 | 51,405 | 77,862 | 77,862 |
| 50% PrEP + 77% ART | 51,727 | 72,912 (58·5%) |
7292 | 3521 (32·9%) |
15·8% | 23,072 | 10,812 (31·5%) |
10,479 | 9,946,036 | 7981 | 95,315 | 89,536 | 103,240 |
| 80% PrEP + 77% ART | 34,994 | 89,645 (71·8%) |
6104 | 4709 (43·9%) |
13·3% | 19,971 | 13,913 (40·6%) |
8573 | 9,977,021 | 11,683 | 126,816 | 98,338 | 124,960 |
| no PrEP + 90% ART | 100,934 | 23,705 (19·0%) |
11,394 | -582 d (-5·6%) |
25·8% | 18,295 | 15,589 (45·9%) |
2349 | 9,976,171 | -128 | 125,211 | Cost-saving | Cost-saving |
| 20% PrEP + 90% ART | 67,106 | 57,533 (44·9%) |
9239 | 1574 (13·4%) |
19·9% | 15,921 | 17,963 (52·4%) |
6216 | 10,005,561 | 3726 | 154,949 | 25,417 | 139,084 |
| 50% PrEP + 90% ART | 43,212 | 81,427 (63·6%) |
7244 | 3569 (31·1%) |
15·8% | 13,981 | 19,903 (57·8%) |
10,526 | 10,029,653 | 8025 | 179,456 | 47,243 | 188,129 |
| 80% PrEP + 90% ART | 29,445 | 95,194 (74·6%) |
5974 | 4838 (43·9%) |
13·6% | 12,524 | 21,360 (62·0%) |
14,248 | 10,045,670 | 11,741 | 195,781 | 63,332 | 243,993 |
PrEP pre-exposure prophylaxis, ART antiretroviral thera\py, ICER incremental cost-effectiveness ratio, QALY quality-adjusted life-year.
a
Costs including PrEP, first- and second-line drugs, HIV testing, genotype resistance testing, associated opportunistic infections, diagnosis and counselling.
b
Costs and quality-adjusted life years (QALYs) are net present values (3% annual discount rate) over 30 years.
c
Incremental costs and QALYs are relative to the status quo.
d
The negative number refers to increased drug-resistant infections compare to base case.