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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The cost-effectiveness of pre-exposure prophylaxis for HIV infection in South African women
Clinical Infectious Diseases, Volume 54, No. 10, Year 2012
Notification
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Description
Background. Recent trials report the short-term efficacy of tenofovir-based pre-exposure prophylaxis (PrEP) for prevention of human immunodeficiency virus (HIV) infection. PrEP's long-term impact on patient outcomes, population-level transmission, and cost-effectiveness remains unknown. Methods. We linked data from recent trials to a computer model of HIV acquisition, screening, and care to project lifetime HIV risk, life expectancy (LE), costs, and cost-effectiveness, using 2 PrEP-related strategies among heterosexual South African women: (1) women receiving no PrEP and (2) women not receiving PrEP (a tenofovirbased vaginal microbicide). We used a South African clinical cohort and published data to estimate population demographic characteristics, age-adjusted incidence of HIV infection, and HIV natural history and treatment parameters. Baseline PrEP efficacy (percentage reduction in HIV transmission) was 39% at a monthly cost of $5 per woman. Alternative parameter values were examined in sensitivity analyses. Results. Among South African women, PrEP reduced mean lifetime HIV risk from 40% to 27% and increased population discounted (undiscounted) LE from 22.51 (41.66) to 23.48 (44.48) years. Lifetime costs of care increased from $7280 to $9890 per woman, resulting in an incremental cost-effectiveness ratio of $2700/year of life saved, and may, under optimistic assumptions, achieve cost savings. Under baseline HIV infection incidence assumptions, PrEP was not cost saving, even assuming an efficacy >60% and a cost <$1. At an HIV infection incidence of 9.1%/year, PrEP achieved cost savings at efficacies ≥50%. Conclusions. PrEP in South African women is very cost-effective by South African standards, conferring excellent value under virtually all plausible data scenarios. Although optimistic assumptions would be required to achieve cost savings, these represent important benchmarks for future PrEP study design. © The Author 2012.
Authors & Co-Authors
Walensky, Rochelle P.
United States, Boston
Massachusetts General Hospital
United States, Boston
Division of Infectious Diseases
United States, Boston
Harvard Medical School
Park, Ji Eun
United States, Boston
Massachusetts General Hospital
Wood, Robin Y.
South Africa, Cape Town
Desmond Tutu Health Foundation
South Africa, Cape Town
University of Cape Town
Freedberg, Kenneth A.
United States, Boston
Massachusetts General Hospital
United States, Boston
Harvard Medical School
Scott, Callie A.
United States, Boston
Massachusetts General Hospital
Bekker, Linda-Gail Gail
South Africa, Cape Town
Desmond Tutu Health Foundation
South Africa, Cape Town
University of Cape Town
Losina, Elena
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard Medical School
United States, Boston
Boston University
Mayer, Kenneth H.
United States, Boston
Division of Infectious Diseases
United States, Boston
Fenway Community Health Center
United States, Boston
Beth Israel Deaconess Medical Center
Seage, George R.
United States, Boston
Center for Biostatistics in Aids Research
Paltiel, A. David
United States, New Haven
Yale School of Medicine
Statistics
Citations: 91
Authors: 10
Affiliations: 11
Identifiers
Doi:
10.1093/cid/cis225
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Participants Gender
Female