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Cost-effectiveness of postexposure prophylaxis after sexual or injection-drug exposure to human immunodeficiency virus.
Arch Intern Med. 2004 Jan 12; 164(1):46-54.AI

Abstract

BACKGROUND

The cost-effectiveness of interventions that provide human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) to individuals after sexual or injection-drug use exposures depends on the distribution of exposure routes, prevalence of infection among source partners, adherence to PEP regimens, medical care costs, and prevailing epidemiologic contexts, among other factors.

OBJECTIVE

To determine the cost-effectiveness of a comprehensive program to prevent HIV infection after sexual or injection-drug use exposure for 401 persons seeking PEP in an urban community.

METHODS

We conducted a retrospective cost analysis to evaluate the cost of the PEP intervention, then combined this information with model-based effectiveness estimates to determine the PEP program's "cost-utility ratio," which is the ratio of net program costs to the total number of quality-adjusted life-years (QALYs) saved by the program.

RESULTS

The average cost of the PEP regimen was $1222, and the total cost of the program was $450 970. The PEP program prevented an estimated 1.26 HIV infections, saved 11.74 QALYs, and averted $281 323 in future HIV-related medical care costs. The overall cost-utility ratio was $14 449 per QALY saved. When analysis was restricted to men reporting receptive anal intercourse, the savings in averted HIV-related medical care costs exceeded the cost of the program. The results were generally robust to changes in key parameter values but were sensitive to assumptions about the HIV transmission probability for receptive anal intercourse.

CONCLUSIONS

For this study population, HIV PEP was cost-effective by conventional standards and cost-saving for persons seeking PEP after male-male receptive anal intercourse.

Authors+Show Affiliations

Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI 53202, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

14718321

Citation

Pinkerton, Steven D., et al. "Cost-effectiveness of Postexposure Prophylaxis After Sexual or Injection-drug Exposure to Human Immunodeficiency Virus." Archives of Internal Medicine, vol. 164, no. 1, 2004, pp. 46-54.
Pinkerton SD, Martin JN, Roland ME, et al. Cost-effectiveness of postexposure prophylaxis after sexual or injection-drug exposure to human immunodeficiency virus. Arch Intern Med. 2004;164(1):46-54.
Pinkerton, S. D., Martin, J. N., Roland, M. E., Katz, M. H., Coates, T. J., & Kahn, J. O. (2004). Cost-effectiveness of postexposure prophylaxis after sexual or injection-drug exposure to human immunodeficiency virus. Archives of Internal Medicine, 164(1), 46-54.
Pinkerton SD, et al. Cost-effectiveness of Postexposure Prophylaxis After Sexual or Injection-drug Exposure to Human Immunodeficiency Virus. Arch Intern Med. 2004 Jan 12;164(1):46-54. PubMed PMID: 14718321.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of postexposure prophylaxis after sexual or injection-drug exposure to human immunodeficiency virus. AU - Pinkerton,Steven D, AU - Martin,Jeffrey N, AU - Roland,Michelle E, AU - Katz,Mitchell H, AU - Coates,Thomas J, AU - Kahn,James O, PY - 2004/1/14/pubmed PY - 2004/3/16/medline PY - 2004/1/14/entrez SP - 46 EP - 54 JF - Archives of internal medicine JO - Arch Intern Med VL - 164 IS - 1 N2 - BACKGROUND: The cost-effectiveness of interventions that provide human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) to individuals after sexual or injection-drug use exposures depends on the distribution of exposure routes, prevalence of infection among source partners, adherence to PEP regimens, medical care costs, and prevailing epidemiologic contexts, among other factors. OBJECTIVE: To determine the cost-effectiveness of a comprehensive program to prevent HIV infection after sexual or injection-drug use exposure for 401 persons seeking PEP in an urban community. METHODS: We conducted a retrospective cost analysis to evaluate the cost of the PEP intervention, then combined this information with model-based effectiveness estimates to determine the PEP program's "cost-utility ratio," which is the ratio of net program costs to the total number of quality-adjusted life-years (QALYs) saved by the program. RESULTS: The average cost of the PEP regimen was $1222, and the total cost of the program was $450 970. The PEP program prevented an estimated 1.26 HIV infections, saved 11.74 QALYs, and averted $281 323 in future HIV-related medical care costs. The overall cost-utility ratio was $14 449 per QALY saved. When analysis was restricted to men reporting receptive anal intercourse, the savings in averted HIV-related medical care costs exceeded the cost of the program. The results were generally robust to changes in key parameter values but were sensitive to assumptions about the HIV transmission probability for receptive anal intercourse. CONCLUSIONS: For this study population, HIV PEP was cost-effective by conventional standards and cost-saving for persons seeking PEP after male-male receptive anal intercourse. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/14718321/Cost_effectiveness_of_postexposure_prophylaxis_after_sexual_or_injection_drug_exposure_to_human_immunodeficiency_virus_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.164.1.46 DB - PRIME DP - Unbound Medicine ER -