HIV pre-exposure prophylaxis (PrEP) could be cost saving for NHS in long run

By Dr. Ananya Mandal, MDOct 18 2017

For men who have sex with men in the UK, a programme that involved providing pre-exposure prophylaxis (PrEP) treatment for HIV could be cost effective and cost saving finds a new study. The economic evaluation was made by a team led by Valentina Cambiano, of University College London and published in the latest issue of Lancet Infectious Diseases.

The team performed an elaborate analysis by assuming various scenarios when it comes to use of PrEP in homosexual men. They altered drug prices, dosing of the PrEP, alterations in the sexual behaviors of the individuals. In each of these assumptions they noted that PrEP was cost saving and cost effective. The only change with each of these scenarios, they write, is the amount of money the NHS would save if they incorporate PrEP in their programmes. Valentina Cambiano said that there was no doubt that PrEP worked both in terms of health benefits and in terms of cost savings. The final result Cambiano said was lower number of men needing lifelong HIV treatment.

This said, the authors agree that initiating and incorporating PrEP into NHS would be a cost consideration. There would be initial costs but in four decades, they explain, the savings would be evident. The savings would be clearer earlier if generic medications are allowed making process more affordable.

PrEP, it was agreed would not be provided to men who were having anal sex with a single HIV positive male partner who had very low or undetectable viral load in their blood. PrEP would be provided before and after sex that has shown to reduce HIV infections in 86% individual cases. The incidence of HIV among men who were eligible but were not taking PrEP, was 2 percent as shown from other studies. PrEP users are to be tested for HIV every three months. PrEP costs £4331 per person annually while HIV treatment costs £6288 per person yearly.

For this study the team of researchers created a mathematical model to estimate the final costs incurred. They assessed how many cases of HIV could be prevented and the number of additional years the men could live in good health. The assessment was done among homosexual men if there is incorporation of PrEP in 2016. This was compared with a scenario where PrEP was not part of the system.

Results from this study showed that around 725,000 homosexual men in UK would be eligible for PrEP. Of these initially only an estimated 4000 men would begin PrEP, the study noted. These numbers are expected to rise to 15000 men in 2030. All these men by then would have had taken an average of 4.5 years of PrEP. An estimated 40000 individuals would have taken PrEP by 2030, the study estimated.

The number of new HIV infections in the next 80 years would be 25 percent less than the current expected numbers if PrEP was introduced, they found. An average of five healthy life years would be added with each of these HIV infections that could be averted.

In total 220,000 healthy life years would be added if PrEP were to be introduced. In the next thirty years the yearly spending on HIV would rise from £450 million in 2016 to around £850 million if PrEP were not introduced. £64 billion would be spent in the next 80 years if PrEP did not come into the picture, they warn. During this time the spending would be lower at £56 billion if PrEP were to be introduced.

The authors conclude in their study, that on analyzing the economic benefits of introducing PrEP among men having sex with men in the UK “is cost-saving and leads to health benefits, caused by a substantial reduction in HIV incidence” among these individuals.

The study was supported by the National Institute for Health Research and Merck Sharp & Dohme.

PrEP

Pre-exposure prophylaxis, or PrEP is given to persons who do not have HIV but are at risk of HIV because they are exposed to it. They need to take a pill every day containing two medicines - tenofovir and emtricitabine (brand name Truvada). If taken regularly, it can stop HIV infection from taking root in the exposed person. It is cited as a “powerful HIV prevention tool” by the CDC and is more effective when combined with condom use. Those taking this pill regimen however need to take it regularly and get tested for HIV every three months.