Cost Effectiveness Of Daily Oral Prep For Msm

1401 WordsDec 6, 20156 Pages
Juusola et al. (2012) added to this literature with a study of the cost-effectiveness of daily oral PrEP for MSM. Using a detailed economic analysis combined with the dynamic progression and transmission of HIV/AIDS model, the researchers assessed PrEP cost-effectiveness (based on clinical trials showing a 44 percent reduction in infection) in the general MSM population, and among high-risk MSM. The results indicate that initiating PrEP in 20 percent of U.S. MSM over 20 years would yield a 13 percent reduction in new infections, for a gain of 550,166 QALYs, at a cost $172,091 per QALY gained. Were PrEP to be initiated in a larger proportion of MSM, more new infections would be averted but at a rising cost per QALY gained. On the other…show more content…
In a MSM cohort with a mean age of 34 years, PrEP reduced lifetime infection risk from 44 percent (without PrEP) to 25 percent. However, mean lifetime treatment costs increased from $81,100 to $232,700 per client. Still, incremental cost-effectiveness ratios were improved when the intervention targeted younger MSM populations with higher incidences of infection, and factored in future improvements in PrEP efficacy and reductions in costs. Thus, the researchers conclude that, while tenofovir-emtricitabine would probably not be cost-effective at current costs, the combination could become cost-effective if its prices were reduced or efficacy improved in the future. Taking another tack, Prabhu et al. (2011) analyze the cost-effectiveness of interventions that focus on identifying and treating persons with HIV early in their disease course. Such early intervention is effective for limiting the impact of the disease (for instance, by using highly active antiretroviral therapy [HAART] to slow its progression). Thus, researchers used the progression and transmission model to compare the cost-effectiveness of HIV screening in two settings where early diagnosis is likely—sexually transmitted disease (STD) clinics serving MSM, and hospital emergency departments (EDs)—versus inpatient units, where later diagnosis is more likely. The model indicated that screening patients in STD clinics, where HIV is apt to be least advanced, the most cost-effective approach.
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