US: PrEP Is Not Cost-Effective at Current Price, Health Economists Find

For years, the U.S. HIV prevention community has known that pre-exposure prophylaxis (PrEP) is prohibitively expensive for many patients who need it. Now, new research presented at the 2019 National HIV Prevention Conference (NHPC) in Atlanta finds that not only is PrEP expensive for individual patients, it's also not cost-effective for the health system as a whole (Abstract 5440).

In general, health economists in the United States agree that an intervention is "cost-effective" if it costs less than $200,000 for every "quality-adjusted life year," or QALY.

But when Nidhi Khurana, Ph.D., prevention effectiveness fellow at the Centers for Disease Control and Prevention (CDC) crunched the numbers for PrEP, she found that it has an incremental cost-effectiveness ratio of $885,867 -- meaning the health care system spends more than $800,000 to keep someone alive, happy, and healthy for one year.

Although PrEP is an important HIV prevention tool that can help avert nearly 20% of new infections per year, "right now, we can't really say that PrEP is cost-effective," said Khurana, lead author of the NHPC paper.

"In order for this to make it cost-effective, we really need to decrease the cost of PrEP," Khurana said.

For this model, Khurana and her colleagues assumed a PrEP list price of $12,599, plus an additional cost of $1,538 for the PrEP program. The model estimated the cost of delivering PrEP from 2016 to 2020 and estimated the redeemed quality-of-life years from 2016 to 2060.

The numbers looked different when broken down by high-risk subgroup. For people who inject drugs, introducing PrEP at current care continuum levels would cost just over $800,000 per QALY gained -- so, about on par with the overall average cost-effectiveness. For men who have sex with men (MSM), the cost-effectiveness improves, dropping to $463,303 per QALY, but for heterosexuals at high risk for HIV, it's more than $3.5 million per QALY.

The numbers get worse once you consider national plans to scale up HIV prevention targets, at which point PrEP would cost $1.7 million per QALY across all high-risk groups. Read more via The Body