1. From: Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States
Ann Intern Med. 2016;165(1): doi: /M
Figure Legend:
We evaluate a program of PrEP with frequent HIV screening and enhanced ART provision (PrEP+screen+ART) with 25% coverage and $10 000 annual PrEP drug cost varying PrEP efficacy from 10% to 90%. The y-axis shows the ICER corresponding to efficacy levels specified on the x-axis. At current drug costs, the cost per QALY gained remains greater than $150 000 for all efficacy levels but substantially decreases as efficacy improves, with the largest jumps in cost-effectiveness coming at lower levels of efficacy. At 49% efficacy (leftmost vertical line), we see our base-case analysis with an ICER of $253 000/QALY gained. The Bangkok Tenofovir Study estimates a 74% reduction (rightmost vertical line) in HIV acquisition for high adherers. This results in a more favorable ICER of $193 000/QALY gained. At a 65% cost reduction PrEP delivers higher value and crosses the $100 000/QALY gained threshold at reported efficacy levels, although low levels of efficacy still result in high ICERs. ART = antiretroviral therapy; ICER = incremental cost-effectiveness ratio; PrEP = preexposure prophylaxis; QALY = quality-adjusted life-year.
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