Table 2.
Model-projected 10-year clinical, cost and cost effectiveness outcomes of CAB-LA vs. generic F/TDF and branded F/TAF for HIV PrEP among MSM/TGW in the US
| Strategy | Total Transmissions, n | Total QALY | Incremental QALY | Total cost, billion* | Incremental cost, billion* | ICER, $/QALY* |
|---|---|---|---|---|---|---|
|
| ||||||
| MSM/TGW at VHR (n=476,700) | ||||||
|
| ||||||
| Generic F/TDF | 122,000 | 4,626,000 | -- | 30.67 | -- | -- |
| No PrEP | 178,000 | 4,529,000 | (97,000) | 33.48 | 2.81 | Excluded |
| Branded F/TAF | 122,000 | 4,628,000 | 99,000 | 60.42 | 29.75 | Excluded† |
| CAB-LA | 107,000 | 4,654,000 | 26,000 | 75.84 | 15.42 | 1,582,000 |
|
| ||||||
| MSM/TGW at HR (n=1,906,800) | ||||||
|
| ||||||
| No PrEP | 197,000 | 16,864,000 | -- | 39.57 | -- | -- |
| Generic F/TDF | 135,000 | 16,982,000 | 118,000 | 44.71 | 5.14 | 43,000 |
| Branded F/TAF | 135,000 | 16,991,000 | 9,000 | 160.09 | 115.37 | Excluded‡ |
| CAB-LA | 119,000 | 17,022,000 | 31,000 | 226.32 | 66.24 | 4,571,000 |
CAB-LA, long-acting injectable cabotegravir; F/TDF, tenofovir disoproxil fumarate-emtricitabine; HR, high risk for HIV; ICER, incremental cost-effectiveness ratio; MSM, men who have sex with men; PrEP, pre-exposure prophylaxis; QALY, quality-adjusted life-year; TGW, transgender women; 2020 USD, 2020 US dollars; VHR, very high risk for HIV.
All economic outcomes are reported in 2020 US dollars with a 3% annual discount rate. CAB-LA economic outcomes (in italics) were modeled using the upper bound drug price for CAB-LA (price $25,850).
Compared to branded F/TAF, CAB-LA would have an incremental cost-effectiveness ratio of $589,000/QALY among MSM/TGW at VHR. Compared to generic F/TDF, branded F/TAF would have an ICER of $12,513,000/QALY.
Compared to branded F/TAF, CAB-LA would have an incremental cost-effectiveness ratio of $2,136,000/QALY among MSM/TGW at HR. Compared to generic F/TDF, branded F/TAF would have an ICER of $13,221,000/QALY.
Strategies are listed in order of increasing cost per cost-effectiveness convention, and increments are expressed compared to the next less costly strategy; the order of strategies may differ throughout the analysis. Results are discounted at 3 percent per year and rounded to the nearest thousand. The ICER is the difference in cost divided by the difference in life expectancy for each strategy compared with the next less costly strategy. Strategies which are “Excluded” represent either a scenario where the strategy costs more and accrues fewer QALYs (as in No PrEP for the VHR analysis) or is a less efficient use of resources than the combination of two other strategies (as in branded F/TAF, also called “extended dominance”). The ICER for CAB-LA in italics represents the comparison to generic F/TDF. CAB-LA would be cost-saving compared to generic F/TDF only at a maximum price premium to generic F/TDF of <$1,900 (CAB-LA price $2,300).