Australian research examining the cost-effectiveness of using pre-exposure prophylaxis (PrEP) as a public health intervention among men who have sex with men (MSM), concluded that PrEP is currently too expensive to be widely used, but is cost effective when targeted specific groups such as to MSM in sero-discordant relationships.
The study, published in Clinical Infectious Diseases in January, used modeling to predict clinical and cost outcomes of providing PrEP to MSM in New South Wales.
Scenarios used in the study included prioritising PrEP to 10-30% of the general MSM population, 15-30% of MSM with more than 10-50 sexual partners per six months, and 15-30% of HIV-negative MSM in discordant regular partnerships. Outcomes were reported as incremental cost effectiveness ratios (ICERs) in 2013 Australian dollars per quality-adjusted life year gained (QALYG).
The use of PrEP in 10-30% of the entire NSW MSM population was projected to cost $316-952 million dollars over the course of 10 years, and cost more than $400,000 per QALYG. The study authors commented that providing PrEP to the general MSM population was not cost-effective, and also said that achieving such high rates of coverage was likely to be quite unrealistic.
Results showed improved cost-effectiveness when targeting a smaller group of MSM at high risk of acquiring HIV. The most cost-effective of these involved targeting HIV-negative men in a discordant regular partnership; ICERs ranged between $8,399 and $11,575 per QALYG for coverage ranging between 15% and 30%, respectively.