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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
Vaccines 2017, 5(2), 13; https://doi.org/10.3390/vaccines5020013
Received: 24 March 2017 / Revised: 7 May 2017 / Accepted: 19 May 2017 / Published: 24 May 2017
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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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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