Cost-effectiveness of HIV postexposure prophylaxis following sexual or injection drug exposure in 96 metropolitan areas in the United States.
OBJECTIVE
To evaluate the cost-effectiveness of HIV postexposure prophylaxis (PEP) following sexual or injection-related exposures in 96 metropolitan statistical areas in the United States (MSA).


METHODS
Empirical, model-based cost-effectiveness analysis.


METHODS
Epidemiological and population size estimates from the literature were combined with information about the distribution of exposure types, PEP completion rate, proportion of source partners known to be HIV infected, and PEP program costs obtained from a feasibility study of PEP in San Francisco to estimate the cost-effectiveness of hypothetical PEP programs in each of the 96 MSA. The effectiveness of combination antiretroviral therapy following sexual or drug use-related exposures, which is presently not known, was assumed equal to the effectiveness of zidovudine monotherapy in the occupational setting. The main outcome measure was the cost-utility ratio, defined as the cost per quality-adjusted life year (QALY) saved by the PEP intervention.


RESULTS
The cost-utility ratios for the 96 MSA ranged from 4137 dollars to 39,101 dollars per QALY saved; only two of the ratios exceeded 30,000 dollars per QALY saved. Combined across the 96 MSA, the hypothetical PEP programs would reach nearly 20,000 clients at a total cost of approximately 22 million dollars. The overall cost-utility ratio across MSA was 12,567 dollars per QALY saved. The majority of the HIV infections prevented by PEP were among men and women who reported receptive anal intercourse exposure.


CONCLUSIONS
PEP following sexual or drug use-related exposures could be a cost-effective complement to existing HIV-prevention efforts in most MSA across the United States.
Pinkerton
Steven D
SD
Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53202, USA. pinkrton@mcw.edu
Martin
Jeffrey N
JN
Roland
Michelle E
ME
Katz
Mitchell H
MH
Coates
Thomas J
TJ
Kahn
James O
JO
D018890:Chemoprevention / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000517:prevention & control*; D020010:Heterosexuality; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D011314:Preventive Health Services / Q000191:economics*; D019057:Quality-Adjusted Life Years; D015819:Substance Abuse, Intravenous / Q000191:economics / Q000821:virology; D014481:United States; D047568:Unsafe Sex; D014504:Urban Health