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Vaccines 2017, 5(2), 13; doi:10.3390/vaccines5020013

The Potential Cost-Effectiveness of Pre-Exposure Prophylaxis Combined with HIV Vaccines in the United States

1
Pharmaceutical Outcomes Research and Policy, Department of Pharmacy, University of Washington, Seattle, WA 98115, USA
2
HIV Vaccine Trials Network, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
3
Department of Global Health, University of Washington, Seattle, WA 98115, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Alfredo Torres
Received: 24 March 2017 / Revised: 7 May 2017 / Accepted: 19 May 2017 / Published: 24 May 2017
View Full-Text   |   Download PDF [3749 KB, uploaded 24 May 2017]   |  

Abstract

This economic evaluation aims to support policy-making on the combined use of pre-exposure prophylaxis (PrEP) with HIV vaccines in development by evaluating the potential cost-effectiveness of implementation that would support the design of clinical trials for the assessment of combined product safety and efficacy. The target study population is a cohort of men who have sex with men (MSM) in the United States. Policy strategies considered include standard HIV prevention, daily oral PrEP, HIV vaccine, and their combination. We constructed a Markov model based on clinical trial data and the published literature. We used a payer perspective, monthly cycle length, a lifetime horizon, and a 3% discount rate. We assumed a price of $500 per HIV vaccine series in the base case. HIV vaccines dominated standard care and PrEP. At current prices, PrEP was not cost-effective alone or in combination. A combination strategy had the greatest health benefit but was not cost-effective (ICER = $463,448/QALY) as compared to vaccination alone. Sensitivity analyses suggest a combination may be valuable for higher-risk men with good adherence. Vaccine durability and PrEP drug prices were key drivers of cost-effectiveness. The results suggest that boosting potential may be key to HIV vaccine value. View Full-Text
Keywords: economic evaluation; mathematical modeling; HIV vaccines; pre-exposure prophylaxis; cost-effectiveness economic evaluation; mathematical modeling; HIV vaccines; pre-exposure prophylaxis; cost-effectiveness
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Adamson, B.J.S.; Carlson, J.J.; Kublin, J.G.; Garrison, L.P., Jr. The Potential Cost-Effectiveness of Pre-Exposure Prophylaxis Combined with HIV Vaccines in the United States. Vaccines 2017, 5, 13.

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