Clinical Infectious Diseases MAJOR ARTICLE HIV/AIDS
Cost-effectiveness of Injectable Preexposure Prophylaxis for HIV Prevention in South Africa Robert L. Glaubius,1 Greg Hood,2 Kerri J. Penrose,3 Urvi M. Parikh,3 John W. Mellors,3 Eran Bendavid,4 and Ume L. Abbas1,5 1 Departments of Infectious Disease and Quantitative Health Sciences, Cleveland Clinic, Ohio; 2Pittsburgh Supercomputing Center, Carnegie Mellon University, and 3Division of Infectious Diseases, School of Medicine, University of Pittsburgh, Pennsylvania; 4Division of Infectious Diseases, Department of Medicine, Stanford University, California; and 5Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
Background. Long-acting injectable antiretrovirals such as rilpivirine (RPV) could promote adherence to preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention. However, the cost-effectiveness of injectable PrEP is unclear. Methods. We constructed a dynamic model of the heterosexual HIV epidemic in KwaZulu-Natal, South Africa, and analyzed scenarios of RPV PrEP scale-up for combination HIV prevention in comparison with a reference scenario without PrEP. We estimated new HIV infections, life-years and costs, and incremental cost-effectiveness ratios (ICERs), over 10-year and lifetime horizons, assuming a societal perspective. Results. Compared with no PrEP, unprioritized scale-up of RVP PrEP covering 2.5%–15% of adults prevented up to 9% of new infections over 10 years. HIV prevention doubled (17%) when the same coverage was prioritized to 20- to 29-year-old women, costing $10 880–$19 213 per infection prevented. Prioritization of PrEP to 80% of individuals at highest behavioral risk achieved comparable prevention (4%–8%) at
Cost-effectiveness of Injectable Preexposure Prophylaxis for HIV Prevention in South Africa Robert L. Glaubius,1 Greg Hood,2 Kerri J. Penrose,3 Urvi M. Parikh,3 John W. Mellors,3 Eran Bendavid,4 and Ume L. Abbas1,5 1 Departments of Infectious Disease and Quantitative Health Sciences, Cleveland Clinic, Ohio; 2Pittsburgh Supercomputing Center, Carnegie Mellon University, and 3Division of Infectious Diseases, School of Medicine, University of Pittsburgh, Pennsylvania; 4Division of Infectious Diseases, Department of Medicine, Stanford University, California; and 5Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
Background. Long-acting injectable antiretrovirals such as rilpivirine (RPV) could promote adherence to preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention. However, the cost-effectiveness of injectable PrEP is unclear. Methods. We constructed a dynamic model of the heterosexual HIV epidemic in KwaZulu-Natal, South Africa, and analyzed scenarios of RPV PrEP scale-up for combination HIV prevention in comparison with a reference scenario without PrEP. We estimated new HIV infections, life-years and costs, and incremental cost-effectiveness ratios (ICERs), over 10-year and lifetime horizons, assuming a societal perspective. Results. Compared with no PrEP, unprioritized scale-up of RVP PrEP covering 2.5%–15% of adults prevented up to 9% of new infections over 10 years. HIV prevention doubled (17%) when the same coverage was prioritized to 20- to 29-year-old women, costing $10 880–$19 213 per infection prevented. Prioritization of PrEP to 80% of individuals at highest behavioral risk achieved comparable prevention (4%–8%) at
