Truvada HIV Prevention: Financial Cost Study and Does it Really Work?

First author of the study, Dr. Jessie Juusola, a PhD candidate in management science and engineering at the Stanford School of Engineering concludes, “promoting PrEP to all men who have sex with men could be prohibitively expensive.” But “adopting it for men who have sex with men at high risk of acquiring HIV is an investment with good value that does not break the bank,” she points out. The gay men who are at highest risk for acquiring AIDS are those who have five or more sex partners a year.

Specifically, prescribing the pill generally to all MSMs in the U.S. would cost US$495 billion over 20 years — but targeting those at highest risk only would bring costs down to $85 billion, the authors write in the Annals of Internal Medicine.

Truvada HIV Prevention Financial Cost Study. Taking the pill as prevention doesn’t make financial sense if taken for life, previous studies showed. But the Stanford team said its formula differed because it presumed just a 20-year period of pill taking.





Looking out over the next two decades, the Stanford researchers calculate:
• A total of 490,000 new infections if PrEP is not used.
• Nearly 63,000 would be prevented if 20 percent of gay men take Truvada daily.
• Nearly 41,000 would be prevented if just 20 percent of MSMs in the high-risk group take the pill daily.

In terms of costs, this is:
• A staggering US$495 billion spent if every MSM used Truvada daily for 20 years.
• US$98 billion spent if 20 percent of the MSM population would take Truvada daily for 20 years.
• US$$16.6 billion spent if just 20 percent of high-risk MSMs took the drug.

Aside from the cost of the drug, the Stanford researchers also took into account in developing their model the expenses for:
• physician visits,
• periodic monitoring of kidney function affected by the drug, and
• regular testing for HIV and sexually transmitted diseases.

“We’re talking about giving uninfected people a drug that has some toxicities, so it’s crucial to have them monitored regularly,” notes senior author Dr. Eran Bendavid, assistant professor of medicine in the Stanford University School of Medicine, an affiliate of Stanford Health Policy, which is part of the Freeman Spogli Institute for International Studies.

They also put forward the following calculations:
• How long people live and their quality of life is valued at US$50,000 per year
• The average costs of the pill and doctor visits totals about $10,000 per year

At less than US$50,000 per quality-adjusted life year gained, the strategy of using Truvada for PrEP for high-risk men represents relatively good value, Dr. Juusola says. This is why giving the pill to high-risk gay men represents good value, she says.

“However, even though it provides good value, it is still very expensive,” she cautions in a university news release. “In the current health-care climate, (these) costs may become prohibitive, especially given the other competing priorities for HIV resources, such as providing treatment for infected individuals.”

“In the current health-care climate, PrEP’s costs may become prohibitive, especially given the other competing priorities for HIV resources, such as providing treatment for infected individuals,” the authors write.

An alternative would be using the pill intermittently, instead of daily. This would reduce the costs significantly — but would it work? Clinical trials are now under way to assess Truvada HIV prevention effectiveness when it is used less often than once a day.

Dr. Margaret Brandeau, the Coleman F. Fung Professor of Engineering, and Dr. Douglas Owens, the Henry J. Kaiser, Jr. Professor at Stanford and senior investigator at the Veterans Affairs Palo Alto Health Care System are also co-authors of the new study. Dr. Owens also is director of Stanford’s Center for Health Policy/Primary Care and Outcomes Research. The study was funded by the National Institutes of Health and the Department of Veterans Affairs.





Truvada HIV Prevention: Financial Cost Study and Does it Really Work? posted 29 April 2012. Latest update on 29 April 2012.