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

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 pub...

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Bibliographic Details
Published in:PloS one Vol. 9; no. 10; p. e108742
Main Authors: Chen, Anders, Dowdy, David W.
Format: Journal Article
Language:English
Published: United States Public Library of Science 2014
Public Library of Science (PLoS)
Subjects:
Acquired immune deficiency syndrome
Adhesion
AIDS
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Calculators
Clinical decision making
Condoms
Cost analysis
Cost engineering
Cost-Benefit Analysis
Decision analysis
Decision Making
Decisions
Disease prevention
Disease transmission
Engineering and Technology
Epidemiology
Exposure
Health risks
HIV
HIV Infections - drug therapy
HIV Infections - economics
HIV Infections - epidemiology
Homosexuality, Male
Human immunodeficiency virus
Humans
Male
Mathematical models
Medicine and health sciences
Men
Monogamy
Parameter estimation
Patients
People and Places
Populations
Pre-Exposure Prophylaxis - economics
Prevalence
Prophylaxis
Public health
Research and Analysis Methods
Risk analysis
Risk Factors
Risk management
Sex
Sexual behavior
Sexually transmitted diseases
Social Sciences
STD
Therapy
Treatment Outcome
World population
United States > US
Maryland
Baltimore Maryland
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Description
Summary: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. 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. 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). PrEP results vary widely across individuals and populations. Risk calculators may aid in patient education, clinical decision-making, and cost-effectiveness evaluation.
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Competing Interests: The authors have declared that no competing interests exist.
Conceived and designed the experiments: AC DWD. Performed the experiments: AC DWD. Analyzed the data: AC DWD. Contributed reagents/materials/analysis tools: AC DWD. Wrote the paper: AC DWD.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0108742