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Estimating the Cost-Effectiveness of Pre-Exposure Prophylaxis to Reduce HIV-1 and HSV-2 Incidence in HIV-Serodiscordant Couples in South Africa

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  • Britta L Jewell
  • Ide Cremin
  • Michael Pickles
  • Connie Celum
  • Jared M Baeten
  • Sinead Delany-Moretlwe
  • Timothy B Hallett

Abstract

Objective: To estimate the cost-effectiveness of daily oral tenofovir-based PrEP, with a protective effect against HSV-2 as well as HIV-1, among HIV-1 serodiscordant couples in South Africa. Methods: We incorporated HSV-2 acquisition, transmission, and interaction with HIV-1 into a microsimulation model of heterosexual HIV-1 serodiscordant couples in South Africa, with use of PrEP for the HIV-1 uninfected partner prior to ART initiation for the HIV-1 1infected partner, and for one year thereafter. Results: We estimate the cost per disability-adjusted life-year (DALY) averted for two scenarios, one in which PrEP has no effect on reducing HSV-2 acquisition, and one in which there is a 33% reduction. After a twenty-year intervention, the cost per DALY averted is estimated to be $10,383 and $9,757, respectively – a 6% reduction, given the additional benefit of reduced HSV-2 acquisition. If all couples are discordant for both HIV-1 and HSV-2, the cost per DALY averted falls to $1,445, which shows that the impact is limited by HSV-2 concordance in couples. Conclusion: After a 20-year PrEP intervention, the cost per DALY averted with a reduction in HSV-2 is estimated to be modestly lower than without any effect, providing an increase of health benefits in addition to HIV-1 prevention at no extra cost. The small degree of the effect is in part due to a high prevalence of HSV-2 infection in HIV-1 serodiscordant couples in South Africa.

Suggested Citation

  • Britta L Jewell & Ide Cremin & Michael Pickles & Connie Celum & Jared M Baeten & Sinead Delany-Moretlwe & Timothy B Hallett, 2015. "Estimating the Cost-Effectiveness of Pre-Exposure Prophylaxis to Reduce HIV-1 and HSV-2 Incidence in HIV-Serodiscordant Couples in South Africa," PLOS ONE, Public Library of Science, vol. 10(1), pages 1-11, January.
    • Handle: RePEc:plo:pone00:0115511
    DOI: 10.1371/journal.pone.0115511
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    References listed on IDEAS

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    1. Nicolas A Menzies & Andres A Berruti & John M Blandford, 2012. "The Determinants of HIV Treatment Costs in Resource Limited Settings," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-9, November.
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