That scenario would see a gain of 2.2 million QALYs, with an incremental cost-effectiveness ratio, compared with no PrEP, of $216,480 per QALY.
On the other hand, if only 20% of men who have sex with men took PrEP, the number of infections prevented and cost would be lower, at 62,759 over 20 years and $95 billion, respectively.
There would be a gain of 550,166 QALYs, with an incremental cost-effectiveness ratio, compared with no PrEP, of $172,091 per QALY.
But targeting just the men who have sex with men considered to be at high risk – those with five or more sex partners a year - would do considerably better, the researchers found.
In that group, thought to be about 20% of all men who have sex with men, starting PrEP would prevent 167,143 new infections over 20 years, at a total cost of $75 billion over current care. And that scenario would gain 1.4 million QALYs, with an incremental cost-effectiveness ratio of $52,443 per QALY, compared with no PrEP.
But even if only one in five of the high-risk population took the daily pill, it would prevent 41,061 new infections over two decades, cost a net of $14 billion, and gain 352,840 QALYs, with a cost-effectiveness ratio of $40,279 compared with no PrEP, they found.
All the models assume that the current cost of the daily pill – about $26 – but analysis found that cost-effectiveness would be better if the cost dropped below $15 or if the risk reduction was greater than 75%.
The study had support from the National Institute on Drug Abuse, the Department of Veterans Affairs, and the National Institute of Allergy and Infectious Diseases. No conflicts were reported.
Primary source: Annals of Internal Medicine
Source reference: Juusola JL, et al “The cost-effectiveness of preexposure prophylaxis for HIV prevention in the United States in men who have sex with men” Ann Intern Med 2012; 156.