Faculty Collaboration Database

Cost-effectiveness of HIV postexposure prophylaxis following sexual or injection drug exposure in 96 metropolitan areas in the United States. AIDS 2004 Oct 21;18(15):2065-73

Date

12/04/2004

Pubmed ID

15577628

DOI

10.1097/00002030-200410210-00011

Scopus ID

2-s2.0-7744236643 (requires institutional sign-in at Scopus site)   52 Citations

Abstract

OBJECTIVES: To evaluate the cost-effectiveness of HIV postexposure prophylaxis (PEP) following sexual or injection-related exposures in 96 metropolitan statistical areas in the United States (MSA).

DESIGN: Empirical, model-based cost-effectiveness analysis.

METHODS: Epidemiological and population size estimates from the literature were combined with information about the distribution of exposure types, PEP completion rate, proportion of source partners known to be HIV infected, and PEP program costs obtained from a feasibility study of PEP in San Francisco to estimate the cost-effectiveness of hypothetical PEP programs in each of the 96 MSA. The effectiveness of combination antiretroviral therapy following sexual or drug use-related exposures, which is presently not known, was assumed equal to the effectiveness of zidovudine monotherapy in the occupational setting. The main outcome measure was the cost-utility ratio, defined as the cost per quality-adjusted life year (QALY) saved by the PEP intervention.

RESULTS: The cost-utility ratios for the 96 MSA ranged from 4137 dollars to 39,101 dollars per QALY saved; only two of the ratios exceeded 30,000 dollars per QALY saved. Combined across the 96 MSA, the hypothetical PEP programs would reach nearly 20,000 clients at a total cost of approximately 22 million dollars. The overall cost-utility ratio across MSA was 12,567 dollars per QALY saved. The majority of the HIV infections prevented by PEP were among men and women who reported receptive anal intercourse exposure.

CONCLUSIONS: PEP following sexual or drug use-related exposures could be a cost-effective complement to existing HIV-prevention efforts in most MSA across the United States.

Author List

Pinkerton SD, Martin JN, Roland ME, Katz MH, Coates TJ, Kahn JO

MESH terms used to index this publication - Major topics in bold

Chemoprevention
Cost-Benefit Analysis
Female
HIV Infections
Heterosexuality
Homosexuality, Male
Humans
Male
Preventive Health Services
Quality-Adjusted Life Years
Substance Abuse, Intravenous
United States
Unsafe Sex
Urban Health