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Cost-effectiveness of HIV nonoccupational post-exposure prophylaxis in Australia.
HIV Med. 2009 Apr; 10(4):199-208.HM

Abstract

OBJECTIVE

The aim of the study was to determine the cost-effectiveness of HIV nonoccupational post-exposure prophylaxis (NPEP) in Australia.

METHODS

A retrospective cost analysis of a population-based observational cohort of 1601 participants eligible for NPEP in Australia between 1998 and 2004 was carried out. We modelled NPEP treatment costs and combined them with effectiveness outcomes to calculate the cost per seroconversion avoided. We estimated the cost-utility of the programme, and sensitivity and threshold analysis was performed on key variables.

RESULTS

The average NPEP cost per patient was A$1616, of which A$848 (52%) was for drugs, A$331 (21%) for consultations, A$225 (14%) for pathology and A$212 (13%) for other costs. The cost per seroconversion avoided in the cohort was A$1 647,476 in our base case analysis, and A$512,410 when transmission rates were set at their maximal values. The cost per quality-adjusted life-year (QALY) was between A$40,673 and A$176,772, depending on the risks of HIV transmission assumed.

CONCLUSIONS

In our base case, NPEP was not a cost-effective intervention compared with the widely accepted Australian threshold of A$50,000 per QALY. It was only cost-effective after receptive unprotected anal intercourse exposure to an HIV-positive source. Although NPEP was a relatively well-targeted intervention in Australia, its cost-effectiveness could be improved by further targeting high-risk exposures.

Authors+Show Affiliations

School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

19207598

Citation

Guinot, D, et al. "Cost-effectiveness of HIV Nonoccupational Post-exposure Prophylaxis in Australia." HIV Medicine, vol. 10, no. 4, 2009, pp. 199-208.
Guinot D, Ho MT, Poynten IM, et al. Cost-effectiveness of HIV nonoccupational post-exposure prophylaxis in Australia. HIV Med. 2009;10(4):199-208.
Guinot, D., Ho, M. T., Poynten, I. M., McAllister, J., Pierce, A., Pell, C., & Grulich, A. E. (2009). Cost-effectiveness of HIV nonoccupational post-exposure prophylaxis in Australia. HIV Medicine, 10(4), 199-208. https://doi.org/10.1111/j.1468-1293.2008.00670.x
Guinot D, et al. Cost-effectiveness of HIV Nonoccupational Post-exposure Prophylaxis in Australia. HIV Med. 2009;10(4):199-208. PubMed PMID: 19207598.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of HIV nonoccupational post-exposure prophylaxis in Australia. AU - Guinot,D, AU - Ho,M T, AU - Poynten,I M, AU - McAllister,J, AU - Pierce,A, AU - Pell,C, AU - Grulich,A E, Y1 - 2009/01/22/ PY - 2009/2/12/entrez PY - 2009/2/12/pubmed PY - 2010/2/23/medline SP - 199 EP - 208 JF - HIV medicine JO - HIV Med VL - 10 IS - 4 N2 - OBJECTIVE: The aim of the study was to determine the cost-effectiveness of HIV nonoccupational post-exposure prophylaxis (NPEP) in Australia. METHODS: A retrospective cost analysis of a population-based observational cohort of 1601 participants eligible for NPEP in Australia between 1998 and 2004 was carried out. We modelled NPEP treatment costs and combined them with effectiveness outcomes to calculate the cost per seroconversion avoided. We estimated the cost-utility of the programme, and sensitivity and threshold analysis was performed on key variables. RESULTS: The average NPEP cost per patient was A$1616, of which A$848 (52%) was for drugs, A$331 (21%) for consultations, A$225 (14%) for pathology and A$212 (13%) for other costs. The cost per seroconversion avoided in the cohort was A$1 647,476 in our base case analysis, and A$512,410 when transmission rates were set at their maximal values. The cost per quality-adjusted life-year (QALY) was between A$40,673 and A$176,772, depending on the risks of HIV transmission assumed. CONCLUSIONS: In our base case, NPEP was not a cost-effective intervention compared with the widely accepted Australian threshold of A$50,000 per QALY. It was only cost-effective after receptive unprotected anal intercourse exposure to an HIV-positive source. Although NPEP was a relatively well-targeted intervention in Australia, its cost-effectiveness could be improved by further targeting high-risk exposures. SN - 1468-1293 UR - https://www.unboundmedicine.com/medline/citation/19207598/Cost_effectiveness_of_HIV_nonoccupational_post_exposure_prophylaxis_in_Australia_ L2 - https://doi.org/10.1111/j.1468-1293.2008.00670.x DB - PRIME DP - Unbound Medicine ER -