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Clinical Effectiveness and Cost-Effectiveness of HIV Pre-Exposure Prophylaxis in Men Who Have Sex with Men: Risk Calculators for Real-World Decision-Making

Author

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  • Anders Chen
  • David W Dowdy

Abstract

Background: Oral pre-exposure prophylaxis (PrEP) can be clinically effective and cost-effective for HIV prevention in high-risk men who have sex with men (MSM). However, individual patients have different risk profiles, real-world populations vary, and no practical tools exist to guide clinical decisions or public health strategies. We introduce a practical model of HIV acquisition, including both a personalized risk calculator for clinical management and a cost-effectiveness calculator for population-level decisions. Methods: We developed a decision-analytic model of PrEP for MSM. The primary clinical effectiveness and cost-effectiveness outcomes were the number needed to treat (NNT) to prevent one HIV infection, and the cost per quality-adjusted life-year (QALY) gained. We characterized patients according to risk factors including PrEP adherence, condom use, sexual frequency, background HIV prevalence and antiretroviral therapy use. Results: With standard PrEP adherence and national epidemiologic parameters, the estimated NNT was 64 (95% uncertainty range: 26, 176) at a cost of $160,000 (cost saving, $740,000) per QALY – comparable to other published models. With high (35%) HIV prevalence, the NNT was 35 (21, 57), and cost per QALY was $27,000 (cost saving, $160,000), and with high PrEP adherence, the NNT was 30 (14, 69), and cost per QALY was $3,000 (cost saving, $200,000). In contrast, for monogamous, serodiscordant relationships with partner antiretroviral therapy use, the NNT was 90 (39, 157) and cost per QALY was $280,000 ($14,000, $670,000). Conclusions: PrEP results vary widely across individuals and populations. Risk calculators may aid in patient education, clinical decision-making, and cost-effectiveness evaluation.

Suggested Citation

  • Anders Chen & David W Dowdy, 2014. "Clinical Effectiveness and Cost-Effectiveness of HIV Pre-Exposure Prophylaxis in Men Who Have Sex with Men: Risk Calculators for Real-World Decision-Making," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-9, October.
    • Handle: RePEc:plo:pone00:0108742
    DOI: 10.1371/journal.pone.0108742
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    Cited by:

    1. Zixin Wang & Yuan Fang & Natthakhet Yaemim & Kai J. Jonas & Andrew Chidgey & Mary Ip & Tommy Cheng & Joseph T. F. Lau, 2021. "Factors Predicting Uptake of Sexually Transmitted Infections Testing among Men Who Have Sex with Men Who Are “Pre-Exposure Prophylaxis Tourists”—An Observational Prospective Cohort Study," IJERPH, MDPI, vol. 18(7), pages 1-15, March.
    2. Stuart J. Wright & William G. Newman & Katherine Payne, 2019. "Accounting for Capacity Constraints in Economic Evaluations of Precision Medicine: A Systematic Review," PharmacoEconomics, Springer, vol. 37(8), pages 1011-1027, August.
    3. Jennie McKenney & Anders Chen & Karen W Hoover & Jane Kelly & David Dowdy & Parastu Sharifi & Patrick S Sullivan & Eli S Rosenberg, 2017. "Optimal costs of HIV pre-exposure prophylaxis for men who have sex with men," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-13, June.
    4. Richard A. Elion & Mina Kabiri & Kenneth H. Mayer & David A. Wohl & Joshua Cohen & Anne C. Beaubrun & Frederick L. Altice, 2019. "Estimated Impact of Targeted Pre-Exposure Prophylaxis: Strategies for Men Who Have Sex with Men in the United States," IJERPH, MDPI, vol. 16(9), pages 1-14, May.

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