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- Title
Daily Oral HIV Pre-exposure Prophylaxis Among Young Men Who Have Sex With Men in the United States: Cost-saving at Generic Drug Price.
- Authors
Amick, Alyssa K; Eskibozkurt, G Ege; Hosek, Sybil G; Flanagan, Clare F; Landovitz, Raphael J; Jin, Elena Y; Wilson, Craig M; Freedberg, Kenneth A; Weinstein, Milton C; Kazemian, Pooyan; Paltiel, A David; Ciaranello, Andrea L; Neilan, Anne M
- Abstract
Background Adherence and retention concerns raise questions about the effectiveness and cost-effectiveness of oral HIV pre-exposure prophylaxis (PrEP) in young men who have sex with men (YMSM). Methods Using an adolescent-focused simulation model, we compared annual HIV screening alone with tenofovir disoproxil fumarate/emtricitabine–based oral PrEP with every 3-month HIV screening in YMSM (aged 15–24) at increased risk of HIV. Data derived from published sources included: age-stratified HIV incidence/100 person-years (PY) on- or off-PrEP (0.6–10.1 or 0.4–6.4), PrEP retention at 6 years (28%), transmissions by HIV RNA level (0.0–78.4/100PY) and annual costs of antiretroviral therapy ($32 000–69 000), HIV care ($3100–34 600), and PrEP program/generic drug ($900/360). Outcomes included transmissions (percent of cohort infected), quality-adjusted life-years (QALYs), costs ($), and incremental cost-effectiveness ratios ($/QALY). We explored the sensitivity of findings to variation in HIV incidence and drug prices. Results Compared with annual screening alone, PrEP would increase QALYs (9.58 to 9.67), reduce new infections (37% to 30%), and decrease costs (by $5000) over 10 years. PrEP would remain cost-saving for HIV incidence off-PrEP ≥5.1/100PY or annual PrEP price ≤$1200. Over a lifetime horizon, PrEP would be cost-saving for HIV incidence off-PrEP ≥1.0/100PY, across all retention assumptions examined. PrEP would not be cost-effective at HIV incidence ≤0.1/100PY, regardless of drug price, due to programmatic costs. Conclusions In US YMSM at increased risk of HIV, generic oral PrEP and every-3-month screening would be cost-saving compared with annual screening alone, even with high discontinuation and low adherence, over a range of HIV incidences.
- Subjects
UNITED States; HIV infection epidemiology; HIV prevention; ORAL drug administration; TENOFOVIR; COST control; MEDICAL screening; ANTIRETROVIRAL agents; DISEASE incidence; MEDICAL care costs; PRE-exposure prophylaxis; AIDS serodiagnosis; COMPARATIVE studies; GENERIC drugs; DESCRIPTIVE statistics; COST effectiveness; RESEARCH funding; MEN who have sex with men; EMTRICITABINE; QUALITY-adjusted life years
- Publication
Clinical Infectious Diseases, 2024, Vol 78, Issue 2, p402
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciad566