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Cost-effectiveness of post-exposure prophylaxis following sexual exposure to HIV.
AIDS. 1998 Jun 18; 12(9):1067-78.AIDS

Abstract

OBJECTIVES

To assess the cost-effectiveness, relative to other health-related interventions in the U.S., of post-exposure prophylaxis (PEP) following potential HIV exposure through sexual contact with a partner who may or may not be infected, and to compare the relative cost-effectiveness of dual- and triple-combination PEP.

METHODS

Standard techniques of cost-utility analysis were used to assess the cost-effectiveness of PEP with a four-week regimen of zidovudine and lamivudine, or zidovudine, lamivudine, and indinavir. Due to a lack of empirical data on the effectiveness of PEP with combination drug regimens, the analysis assumed that combination PEP was no more effective than PEP with zidovudine alone. The main outcome variable is the cost per quality-adjusted life year (QALY) saved by the program.

RESULTS

Providing PEP to a cohort of 10,000 patients who report receptive anal intercourse with a partner of unknown HIV status (who is assumed to be infected with probability equal to 0.18) would prevent about 20 infections, at an average net cost of about US$ 70,000 per infection averted. The cost-utility ratio, US$ 6316 per QALY saved, indicates that PEP is highly cost-effective in this instance. Moreover, triple-combination PEP would need to be about 9% more effective than dual-combination PEP for the addition of indinavir to the regimen to be considered cost-effective. Prophylaxis following receptive vaginal exposure is cost-effective only when it is nearly certain that the partner is infected; PEP for insertive anal and vaginal intercourse does not appear to be cost-effective.

CONCLUSIONS

From a purely economic standpoint, PEP should be restricted to partners of infected persons (e.g., serodiscordant couples), to patients reporting unprotected receptive anal intercourse (including condom breakage), and possibly to cases where there is a substantial likelihood that the partner is infected. Providing PEP to all who request it does not appear to be an economically efficient use of limited HIV prevention and treatment resources.

Authors+Show Affiliations

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

Pub Type(s)

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

Language

eng

PubMed ID

9662204

Citation

Pinkerton, S D., et al. "Cost-effectiveness of Post-exposure Prophylaxis Following Sexual Exposure to HIV." AIDS (London, England), vol. 12, no. 9, 1998, pp. 1067-78.
Pinkerton SD, Holtgrave DR, Bloom FR. Cost-effectiveness of post-exposure prophylaxis following sexual exposure to HIV. AIDS. 1998;12(9):1067-78.
Pinkerton, S. D., Holtgrave, D. R., & Bloom, F. R. (1998). Cost-effectiveness of post-exposure prophylaxis following sexual exposure to HIV. AIDS (London, England), 12(9), 1067-78.
Pinkerton SD, Holtgrave DR, Bloom FR. Cost-effectiveness of Post-exposure Prophylaxis Following Sexual Exposure to HIV. AIDS. 1998 Jun 18;12(9):1067-78. PubMed PMID: 9662204.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of post-exposure prophylaxis following sexual exposure to HIV. AU - Pinkerton,S D, AU - Holtgrave,D R, AU - Bloom,F R, PY - 1998/7/14/pubmed PY - 1998/7/14/medline PY - 1998/7/14/entrez SP - 1067 EP - 78 JF - AIDS (London, England) JO - AIDS VL - 12 IS - 9 N2 - OBJECTIVES: To assess the cost-effectiveness, relative to other health-related interventions in the U.S., of post-exposure prophylaxis (PEP) following potential HIV exposure through sexual contact with a partner who may or may not be infected, and to compare the relative cost-effectiveness of dual- and triple-combination PEP. METHODS: Standard techniques of cost-utility analysis were used to assess the cost-effectiveness of PEP with a four-week regimen of zidovudine and lamivudine, or zidovudine, lamivudine, and indinavir. Due to a lack of empirical data on the effectiveness of PEP with combination drug regimens, the analysis assumed that combination PEP was no more effective than PEP with zidovudine alone. The main outcome variable is the cost per quality-adjusted life year (QALY) saved by the program. RESULTS: Providing PEP to a cohort of 10,000 patients who report receptive anal intercourse with a partner of unknown HIV status (who is assumed to be infected with probability equal to 0.18) would prevent about 20 infections, at an average net cost of about US$ 70,000 per infection averted. The cost-utility ratio, US$ 6316 per QALY saved, indicates that PEP is highly cost-effective in this instance. Moreover, triple-combination PEP would need to be about 9% more effective than dual-combination PEP for the addition of indinavir to the regimen to be considered cost-effective. Prophylaxis following receptive vaginal exposure is cost-effective only when it is nearly certain that the partner is infected; PEP for insertive anal and vaginal intercourse does not appear to be cost-effective. CONCLUSIONS: From a purely economic standpoint, PEP should be restricted to partners of infected persons (e.g., serodiscordant couples), to patients reporting unprotected receptive anal intercourse (including condom breakage), and possibly to cases where there is a substantial likelihood that the partner is infected. Providing PEP to all who request it does not appear to be an economically efficient use of limited HIV prevention and treatment resources. SN - 0269-9370 UR - https://www.unboundmedicine.com/medline/citation/9662204/Cost_effectiveness_of_post_exposure_prophylaxis_following_sexual_exposure_to_HIV_ L2 - https://Insights.ovid.com/pubmed?pmid=9662204 DB - PRIME DP - Unbound Medicine ER -