Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States

Bernard, Cora L; Brandeau, Margaret L.; Humphreys, Keith; Bendavid, Eran; Holodniy, Mark; Weyant, Christopher; Owens, Douglas K; Goldhaber-Fiebert, Jeremy D.

doi:10.7326/m15-2634

Cited by 46 publications

(59 citation statements)

References 52 publications

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“…The PrEP-alone cost-effectiveness findings align with Juusola et al, who estimated PrEP for all MSM costs $216,480 per QALY gained (differing 5% from our ICER for this population) [19]. Similarly, PrEP for injection drug users in the US was estimated by Bernard et al to cost $253,000 per QALY gained [20]. Our conclusion on the potential cost-savings with HIV vaccines is consistent with Long et al in scenarios with similar assumptions [56].…”

Section: Discussionsupporting

confidence: 75%

“…Previous economic evaluations have separately examined the cost-effectiveness of PrEP or HIV vaccines in the US, but none have modeled the potential outcomes when combining these products [18][19][20][21][22][23], as shown in a recent review of HIV vaccine cost-effectiveness studies [24]. For treatment of HIV, Truvada® is highly cost-effective when used in combination with other drugs, but the costeffectiveness estimates for prevention are mixed in reviews [21,25,26].…”

Section: Introductionmentioning

confidence: 99%

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Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

Adamson¹,

Carlson²,

Kublin³

et al. 2017

Preprint

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This economic evaluation aims to support policy-making on the combined use of preexposure prophylaxis (PrEP) with HIV vaccines by evaluating the potential cost-effectiveness of implementation that would support the design of clinical trials for assessment of combined product safety and efficacy. The target study population is a cohort of men who have sex with men (MSM) in the United States. Policy strategies considered include standard HIV prevention, daily oral PrEP, HIV vaccine, and their combination. We constructed a Markov model based on clinical trial data and published literature. We used a payer perspective, monthly cycle length, a lifetime horizon, and a 3% discount rate. We assumed a price of $500 per HIV vaccine series in the base case. HIV vaccines dominated standard care and PrEP. At current prices,PrEP was not cost-effective alone or in combination. A combination strategy had the greatest health benefit but was not cost-effective (ICER=$463,448/QALY) as compared to vaccination alone. Sensitivity analyses suggest a combination may be valuable for higher-risk men with good adherence. Vaccine durability and PrEP drug prices were key drivers of cost-effectiveness. Results suggest that boosting potential may be key to HIV vaccine value.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

Adamson¹,

Carlson²,

Kublin³

et al. 2017

Preprint

View full text Add to dashboard Cite

show abstract

“…A recent cost-effectiveness evaluation of broad PrEP engagement among PWID determined that the cost per quality-adjusted life year gained exceeds $250,000 (Bernard et al, 2016). This high cost is due, in part, to the success of other harm reduction strategies suppressing the rate of HIV transmission.…”

Section: Introductionmentioning

confidence: 99%

PrEP awareness, eligibility, and interest among people who inject drugs in Baltimore, Maryland

Sherman

Schneider

Park

et al. 2019

Drug and Alcohol Dependence

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Background: Limited research has examined pre-exposure prophylaxis (PrEP) interest among people who inject drugs (PWID). To date, few studies have examined the relationship between PrEP eligibility and PrEP interest among PWID. Methods: Data were from an anonymous, cross-sectional survey of Baltimore Syringe Services Program (SSP) clients and non-client peers, restricted to HIV-uninfected participants (N=265). Participants were classified as PrEP eligible/ineligible based on injection related criteria outlined in the CDC’s PrEP guidelines. Participants were asked if they were previously aware of PrEP, would be interested in taking PrEP, and the ease of taking PrEP daily. Participants self-reported their sociodemographic characteristics, health diagnoses, and recent drug use, overdose, and drug treatment history. We estimated bivariate and multivariate logistic regression models to test for significant predictors of interest in PrEP. Results: One-quarter of PWID had previously heard of PrEP and 63% of the sample was interested in taking PrEP. Only two respondents were currently taking PrEP. The majority (89%) thought taking PrEP every day would be easy. In the presence of other variables, PrEP interest was associated with PrEP eligibility (adjusted odds ratio [aOR]=2.46; 95% Confidence Interval [CI]:1.34,4.50) and the number of medical diagnoses (aOR=1.16; 95% CI:1.01,1.33) Conclusions: Most PWID were unaware of PrEP but interested in taking it. PWID who were eligible for PrEP are more likely to be interested in taking it. Having co-morbid conditions was an important correlate of PrEP interest. These results underscore the importance of providers across the healthcare sector engaging PWID in discussions about PrEP.

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“…Nonetheless, PrEP for PWID is expensive in terms of total budget outlay and ICER, although it could be considered cost-effective in the highest prevalence communities [16]. …”

Section: Methodsmentioning

confidence: 99%

“…To address this, we extended an empirically calibrated model of the US HIV epidemic [16] to assess the cost-effectiveness of alternative HIV prevention portfolios for US PWID. Each portfolio included some combination of OAT, NSPs, Test & Treat, and PrEP scaled to various coverage levels.…”

Section: Introductionmentioning

confidence: 99%

Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: A model-based analysis

et al. 2017

Self Cite

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BackgroundThe risks of HIV transmission associated with the opioid epidemic make cost-effective programs for people who inject drugs (PWID) a public health priority. Some of these programs have benefits beyond prevention of HIV—a critical consideration given that injection drug use is increasing across most United States demographic groups. To identify high-value HIV prevention program portfolios for US PWID, we consider combinations of four interventions with demonstrated efficacy: opioid agonist therapy (OAT), needle and syringe programs (NSPs), HIV testing and treatment (Test & Treat), and oral HIV pre-exposure prophylaxis (PrEP).Methods and findingsWe adapted an empirically calibrated dynamic compartmental model and used it to assess the discounted costs (in 2015 US dollars), health outcomes (HIV infections averted, change in HIV prevalence, and discounted quality-adjusted life years [QALYs]), and incremental cost-effectiveness ratios (ICERs) of the four prevention programs, considered singly and in combination over a 20-y time horizon. We obtained epidemiologic, economic, and health utility parameter estimates from the literature, previously published models, and expert opinion. We estimate that expansions of OAT, NSPs, and Test & Treat implemented singly up to 50% coverage levels can be cost-effective relative to the next highest coverage level (low, medium, and high at 40%, 45%, and 50%, respectively) and that OAT, which we assume to have immediate and direct health benefits for the individual, has the potential to be the highest value investment, even under scenarios where it prevents fewer infections than other programs. Although a model-based analysis can provide only estimates of health outcomes, we project that, over 20 y, 50% coverage with OAT could avert up to 22,000 (95% CI: 5,200, 46,000) infections and cost US$18,000 (95% CI: US$14,000, US$24,000) per QALY gained, 50% NSP coverage could avert up to 35,000 (95% CI: 8,900, 43,000) infections and cost US$25,000 (95% CI: US$7,000, US$76,000) per QALY gained, 50% Test & Treat coverage could avert up to 6,700 (95% CI: 1,200, 16,000) infections and cost US$27,000 (95% CI: US$15,000, US$48,000) per QALY gained, and 50% PrEP coverage could avert up to 37,000 (22,000, 58,000) infections and cost US$300,000 (95% CI: US$162,000, US$667,000) per QALY gained. When coverage expansions are allowed to include combined investment with other programs and are compared to the next best intervention, the model projects that scaling OAT coverage up to 50%, then scaling NSP coverage to 50%, then scaling Test & Treat coverage to 50% can be cost-effective, with each coverage expansion having the potential to cost less than US$50,000 per QALY gained relative to the next best portfolio. In probabilistic sensitivity analyses, 59% of portfolios prioritized the addition of OAT and 41% prioritized the addition of NSPs, while PrEP was not likely to be a priority nor a cost-effective addition. Our findings are intended to be illustrative, as data on achievable coverage are limite...

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Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States

Cited by 46 publications

References 52 publications

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

PrEP awareness, eligibility, and interest among people who inject drugs in Baltimore, Maryland

Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: A model-based analysis

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