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Optimal costs of HIV pre-exposure prophylaxis for men who have sex with men

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  • Jennie McKenney
  • Anders Chen
  • Karen W Hoover
  • Jane Kelly
  • David Dowdy
  • Parastu Sharifi
  • Patrick S Sullivan
  • Eli S Rosenberg

Abstract

Introduction: Men who have sex with men (MSM) are disproportionately affected by HIV due to their increased risk of infection. Oral pre-exposure prophylaxis (PrEP) is a highly effictive HIV-prevention strategy for MSM. Despite evidence of its effectiveness, PrEP uptake in the United States has been slow, in part due to its cost. As jurisdictions and health organizations begin to think about PrEP scale-up, the high cost to society needs to be understood. Methods: We modified a previously-described decision-analysis model to estimate the cost per quality-adjusted life-year (QALY) gained, over a 1-year duration of PrEP intervention and lifetime time horizon. Using updated parameter estimates, we calculated: 1) the cost per QALY gained, stratified over 4 strata of PrEP cost (a function of both drug cost and provider costs); and 2) PrEP drug cost per year required to fall at or under 4 cost per QALY gained thresholds. Results: When PrEP drug costs were reduced by 60% (with no sexual disinhibition) to 80% (assuming 25% sexual disinhibition), PrEP was cost-effective (at

Suggested Citation

  • Jennie McKenney & Anders Chen & Karen W Hoover & Jane Kelly & David Dowdy & Parastu Sharifi & Patrick S Sullivan & Eli S Rosenberg, 2017. "Optimal costs of HIV pre-exposure prophylaxis for men who have sex with men," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-13, June.
    • Handle: RePEc:plo:pone00:0178170
    DOI: 10.1371/journal.pone.0178170
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    References listed on IDEAS

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    1. Wolfgang C. Winkelmayer & Milton C. Weinstein & Murray A. Mittleman & Robert J. Glynn & Joseph S. Pliskin, 2002. "Health Economic Evaluations: The Special Case of End-Stage Renal Disease Treatment," Medical Decision Making, , vol. 22(5), pages 417-430, October.
    2. Anders Chen & David W Dowdy, 2014. "Clinical Effectiveness and Cost-Effectiveness of HIV Pre-Exposure Prophylaxis in Men Who Have Sex with Men: Risk Calculators for Real-World Decision-Making," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-9, October.
    3. Rena M. Conti & Ernst R. Berndt, 2014. "Specialty drug prices and utilization after loss of U.S. patent exclusivity, 2001-2007," NBER Working Papers 20016, National Bureau of Economic Research, Inc.
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    1. Alina Cernasev & Crystal Walker & Caylin Kerr & Rachel E. Barenie & Drew Armstrong & Jay Golden, 2022. "Tennessee Pharmacists’ Opinions on Barriers and Facilitators to Initiate PrEP: A Qualitative Study," IJERPH, MDPI, vol. 19(14), pages 1-9, July.

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