Cost-effectiveness of HIV post-exposure prophylaxis in France.
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.


CONCLUSIONS
Overall, the French PEP programme is only moderately cost effective. PEP guidelines should be revised to target high-risk exposures better.
Herida
Magid
M
Department of Infectious Diseases, Institut de Veille Sanitaire, 12 rue du Val d'Osne, 94415 Saint-Maurice cedex, France. magid.herida@ecdc.eu.int
Larsen
Christine
C
Lot
Florence
F
Laporte
Anne
A
Desenclos
Jean-Claude
JC
Hamers
Françoise F
FF
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects; D019057:Quality-Adjusted Life Years; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D047568:Unsafe Sex