To be accessible, PrEP need high levels of adherence.

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A study in New York City in which he presented a model of the acceptance of pre-exposure prophylaxis (PrEP) proved that for economic result, this strategy should be very targeted to men who have sex with men (MSM) that are at increased risk of HIV infection. Within this target population would require high levels of use for the maximum use of this preventive strategy.

Also useful would be a reduction in price Truvada (one tablet currently combining tenofovir and emtricitabine, and the only drug that is used in PrEP). The model presented several scenarios and found that although PrEP could potentially be cost-effective to the current price of Truvada, only imply an economy if it were reduced to half its current price in the US. Even in this case, an almost universal acceptance by the population of gay men at greater risk would be required.

The model does not match any scenario in which PrEP result cost-effective if it were offered to heterosexual people most vulnerable and virtually nothing cost-effective if it were offered to people who use injection drugs.

The cost that would offer PrEP to the general population would be enormous and would completely uneconomical. If PrEP was offered to the entire population without HIV, the model predicts that would be avoided 29% of all HIV infections at a price of 52 billion dollars a year for each prevented infection. If it were offered to men who have sex with men, 19% of all Infecciones would be avoided and it would 1,24 million per avoided infection. However, if it were focused on MSM who have "multiple concurrent relationships," would cost about 740.000 dollars per infection avoided in life and the grandson annual cost would be 467 million.

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By assuming an efficacy of PrEP in 75% rather than 44% (to collect the highest participation rates recorded in the US headquarters of the iPrEx study), 22% of HIV infections could be avoided for the same price and imply that PrEP enter the scope of cost-effective interventions.

If the price of the drug was reduced to half and coverage in gay men in high-risk situation came to 70%, PrEP could actually start saving money. The PrEP program would cost less that antiretroviral therapy in life for HIV infections that would have been produced if not for prophylaxis.

This model was applied in the UK, but the figures obtained by show that PrEP was taken by 30% of gay men who come to sexual health clinics diagnosed with an infection of acute sexually transmitted (closely related to a later high risk of HIV infection), its cost would not exceed the 38.000 pounds per HIV infection averted and probably less if used the actual cost of Truvada and medical care in the UK. This figure is close to the cost-effectiveness threshold used generally 30.000 pounds.

Comment: PrEP may result cost-effective and even assume a cash economy in countries with high levels of admissions and high prices of drugs, suggests this mathematical model. However, for this to occur it is necessary that its use is restricted to those who most need it, you need to maintain membership levels and the price of drugs would need to be reduced, probably considerably, something that is unlikely to occur to 2017-2018 as very early, at the expiry of the patent for Tenofovir.


Diana Margarita

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