Pre-exposure prophylaxis for HIV prevention cost-effective
Introducing a pre-exposure prophylaxis (PrEP) programme for HIV prevention in the UK for men who have sex with men (MSM) is a cost-effective approach, according to a new study funded by the National Institute for Health Research (NIHR) and published in The Lancet Infectious Diseases (DOI: http://dx.doi.org/10.1016/S1473-3099(17)30540-6).
Researchers from the Institute for Global Health, University College London, used surveillance data from Public Health England as well as data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) in an economic model to evaluate the introduction of a PrEP programme using emtricitabine and tenofovir disoproxil for high-risk MSM who had a negative HIV test at baseline. The main outcomes assessed were the number of HIV infections, quality-adjusted life years (QALYs) gained, and costs incurred.
The authors estimate that initiating PrEP in around 4000 MSM by the end of the first year and nearly 40,000 MSM by the end of the 15th year would result in a total cost saving of £1 billion, prevent a quarter of HIV infections (42% as directly result of PrEP), and result in a total of 40,000 discounted QALYs gained over an 80-year time horizon. They add that a reduction in the cost of antiretroviral drugs as new generic versions emerge would substantially shorten the time for these cost savings to be realised.
In April, Scotland became the first place in the UK to offer emtricitabine/tenofovir disoproxil as PrEP for HIV-1 prevention in high-risk adults on the NHS, following a positive decision by the Scottish Medicines Consortium (SMC). PrEP is also currently being trialled by the NHS in England in approximately 10,000 people over a three-year period, to gather new clinical evidence on implementation on a large scale in order to inform future routine commissioning