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Second UK cost-effectiveness study finds that large PrEP programmes may need drug price cut to be affordable
Gus Cairns, 2015-09-25 08:40:00

A second UK cost-effectiveness study of pre-exposure prophylaxis has concluded that a medium-sized PrEP rollout programme that started in 2016 and which immediately offered tenofovir/emtricitabine (Truvada) as daily PrEP to 5,000 gay men at risk of HIV infection would not be cost-effective unless the price of Truvada was cut substantially.

The model is based on the observed HIV infection rates in sexual health clinic attendees, rather than the higher infection rates seen in those not taking PrEP in the groundbreaking PROUD study.

The base-case scenario it presents also assumes that, due to lower adherence and falls in condom use in those taking PrEP, its effectiveness will not be as great in a public provision programme as it has been in recent studies. And it assumes that the cost of HIV treatment will, in future, fall considerably, and at a faster rate than the cost of PrEP.

The model, from researchers at Public Health England (PHE), was presented at their recent conference on 15-16 September.

At present-day prices, it calculates, the cost per person of offering PrEP would exceed the cost of the HIV infections that would occur otherwise, if PrEP is not offered, by £34,000. This is called its incremental cost-effectiveness ratio or ICER. An ICER this size would exceed the usual criterion for cost-effectiveness within the NHS (£20,000-£30,000 per person).

The absolute cost of providing PrEP to 5,000 gay men would be £26.8 million per year. This money would eventually be recouped if cumulative reductions in HIV incidence were maintained – but not for 48 years.

Source:1