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Cost-effectiveness of HIV post-exposure prophylaxis in France.
AIDS. 2006 Aug 22; 20(13):1753-61.AIDS

Abstract

OBJECTIVE

To assess the cost-effectiveness of HIV post-exposure prophylaxis (PEP) in France.

METHODS

We used a decision tree to evaluate, from a society's perspective, the cost of PEP per quality-adjusted life-year (QALY) saved. We used 1999-2003 PEP surveillance data and literature-derived data on per event transmission probabilities, PEP efficacy and quality of life with HIV. HIV prevalence and lifetime cost of HIV/AIDS management in the HAART era were derived from French studies. We assumed that mean life expectancy in full health was 65 years among uninfected individuals and that the mean survival time after HIV infection was 22.5 years. The costs of PEP drugs and follow-up were derived from the French public sector. A 3% annual rate was used to discount future costs and effects.

RESULTS

During 1999-2003, PEP was prescribed to 8958 individuals (heterosexual sex: 47.6%; homosexual sex: 28.4%; occupational exposure: 23.4%; drug injection: 0.6%); of those, 2143 were exposed to a known HIV-infected source. PEP was estimated to prevent 7.7 infections and saved 64.5 QALY at a net cost of euro 5.7 million, resulting in an overall cost-effectiveness ratio of euro 88,692 per QALY saved. PEP was cost saving for 4.4% of cases and cost effective (< euro 50,000 per QALY) in a further 11.3% of cases. In contrast, 72 and 52% of prescriptions had a cost-effectiveness ratio exceeding euro 200,000 and euro 2 millions, respectively, per QALY saved.

CONCLUSION

Overall, the French PEP programme is only moderately cost effective. PEP guidelines should be revised to target high-risk exposures better.

Authors+Show Affiliations

Department of Infectious Diseases, Institut de Veille Sanitaire, 12 rue du Val d'Osne, 94415 Saint-Maurice cedex, France. magid.herida@ecdc.eu.intNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16931940

Citation

Herida, Magid, et al. "Cost-effectiveness of HIV Post-exposure Prophylaxis in France." AIDS (London, England), vol. 20, no. 13, 2006, pp. 1753-61.
Herida M, Larsen C, Lot F, et al. Cost-effectiveness of HIV post-exposure prophylaxis in France. AIDS. 2006;20(13):1753-61.
Herida, M., Larsen, C., Lot, F., Laporte, A., Desenclos, J. C., & Hamers, F. F. (2006). Cost-effectiveness of HIV post-exposure prophylaxis in France. AIDS (London, England), 20(13), 1753-61.
Herida M, et al. Cost-effectiveness of HIV Post-exposure Prophylaxis in France. AIDS. 2006 Aug 22;20(13):1753-61. PubMed PMID: 16931940.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of HIV post-exposure prophylaxis in France. AU - Herida,Magid, AU - Larsen,Christine, AU - Lot,Florence, AU - Laporte,Anne, AU - Desenclos,Jean-Claude, AU - Hamers,Françoise F, PY - 2006/8/26/pubmed PY - 2007/6/30/medline PY - 2006/8/26/entrez SP - 1753 EP - 61 JF - AIDS (London, England) JO - AIDS VL - 20 IS - 13 N2 - OBJECTIVE: To assess the cost-effectiveness of HIV post-exposure prophylaxis (PEP) in France. METHODS: We used a decision tree to evaluate, from a society's perspective, the cost of PEP per quality-adjusted life-year (QALY) saved. We used 1999-2003 PEP surveillance data and literature-derived data on per event transmission probabilities, PEP efficacy and quality of life with HIV. HIV prevalence and lifetime cost of HIV/AIDS management in the HAART era were derived from French studies. We assumed that mean life expectancy in full health was 65 years among uninfected individuals and that the mean survival time after HIV infection was 22.5 years. The costs of PEP drugs and follow-up were derived from the French public sector. A 3% annual rate was used to discount future costs and effects. RESULTS: During 1999-2003, PEP was prescribed to 8958 individuals (heterosexual sex: 47.6%; homosexual sex: 28.4%; occupational exposure: 23.4%; drug injection: 0.6%); of those, 2143 were exposed to a known HIV-infected source. PEP was estimated to prevent 7.7 infections and saved 64.5 QALY at a net cost of euro 5.7 million, resulting in an overall cost-effectiveness ratio of euro 88,692 per QALY saved. PEP was cost saving for 4.4% of cases and cost effective (< euro 50,000 per QALY) in a further 11.3% of cases. In contrast, 72 and 52% of prescriptions had a cost-effectiveness ratio exceeding euro 200,000 and euro 2 millions, respectively, per QALY saved. CONCLUSION: Overall, the French PEP programme is only moderately cost effective. PEP guidelines should be revised to target high-risk exposures better. SN - 0269-9370 UR - https://www.unboundmedicine.com/medline/citation/16931940/Cost_effectiveness_of_HIV_post_exposure_prophylaxis_in_France_ L2 - https://doi.org/10.1097/01.aids.0000242822.74624.5f DB - PRIME DP - Unbound Medicine ER -