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PrEP would save the NHS money, in numerous scenarios
Roger Pebody, 2017-10-17 23:30:00

A PrEP programme for men who have sex with men in the UK would not only be cost-effective, but actually cost-saving (in other words, both improving health and lowering NHS spending), according to an economic evaluation published by Valentina Cambiano and colleagues in the Lancet Infectious Diseases today.

Modifying a wide range of assumptions – drug prices, event-based or daily PrEP dosing, changes in sexual behaviour and so on – did have an impact on the results, but in all the scenarios examined, PrEP remained cost-saving. In other words, those factors only decreased or increased the amount of money the NHS would save by introducing PrEP.

“There is no doubt about the effectiveness of PrEP," commented Valentina Cambiano of University College London. "In addition to delivering a substantial health benefit, our work suggests that introduction of PrEP will ultimately lead to a saving in costs, as a result of decreased numbers of men in need of lifelong HIV treatment.” 

Nonetheless the medium-term budgetary impact of PrEP for the NHS is not trivial. During the first two decades of a PrEP programme, there will be extra costs associated with introducing PrEP. The researchers found that the savings in NHS costs will likely be seen within 40 years – but sooner if the availability of generic medications makes prices fall substantially.

The greater the reduction in drug costs, the sooner PrEP will be cost-saving. In a linked comment article, Paul Revill of the University of York says: “These findings therefore call for NHS policy makers to negotiate with manufacturers to get favourable deals on prices and to be far sighted: invest now and reap long-term gains. This approach is currently challenging when unmet needs across all areas of health care are so great and NHS resources are stretched so thinly. However, this study provides the definitive evidence to support such a decision.”