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Provision of PrEP in the UK will be cost-effective for gay men at high risk of HIV, model finds
Gus Cairns, 2015-06-01 12:20:00
A cost-effectiveness model of HIV pre-exposure prophylaxis (PrEP) for gay men based on the data from the PROUD study, and adapted to the UK epidemic, finds that providing PrEP from 2016 on will be cost-effective if gay men continue to test for HIV at the current rate, are referred for PrEP using the same criteria as PROUD, and do not substantially reduce their existing rates of condom use.
In this base-case scenario, PrEP would cost £9466 for each additional healthy life year gained (quality-adjusted life year or QALY), compared with not introducing PrEP.
This is the case if current list prices of drugs remain as they are. However the two drugs in Truvada (tenofovir + emtricitabine), the pill used in PROUD, come off patent from 2017 onwards. If these drugs and other drugs used to treat HIV are halved in price when their patents expire then PrEP could even be cost saving, resulting in the NHS paying less than it would have done had PrEP not been introduced.
This assumes, however, that there is no increase in HIV testing rates because gay men hear about PrEP and want to get it, or that men who currently use condoms 100% choose to start using PrEP instead of condoms.
What would happen if large-scale interest in PrEP led to an upsurge in HIV testing in gay men, especially if PrEP’s popularity also led to fewer men using condoms? In this case, PrEP would not be cost-effective unless drug prices fall substantially – by 50% to 80% - after drug patents expire.
The model finds that PrEP would be cost-effective if different definitions of ‘higher risk’ are used too. If PrEP is only offered to gay men who have had condomless sex with at least five partners in any three-month period in the last year, then PrEP would be cost-saving even at current drug prices.
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