Mathematical models and health economic aspects of microbicides.
OBJECTIVE
This paper reviews the literature of mathematical modeling and health economics of microbicides. These analyses can aid decision-making for microbicide development, usage in a population, and allocation of limited resources to maximize HIV prevention.


RESULTS
Mathematical models initially forecasted the large positive impact of moderately effective microbicides. These models also predicted that condom replacement would not be a significant concern in most populations. Modeling studies have also considered biophysical interactions of HIV with microbicide gels, the impact of rectal microbicides among gay men, and behavioral and epidemiological factors that are likely to be important. Recent innovative modeling has shown that second-generation microbicides, containing antiretroviral drugs, could lead to high rates of drug resistance when used in public health interventions even if resistance is not detected during clinical trials. Limited analysis of microbicide cost-effectiveness has occurred to date. We provide an analysis of microbicide cost-effectiveness and find that it is highly dependent on HIV incidence in the population and microbicide dosing frequency.


CONCLUSIONS
Modeling has been influential in forecasting the potential public health benefit of microbicides and in warning of possible risks. Models of microbicide cost-effectiveness provide important perspectives in guiding access to future microbicides.
National Centre in HIV Epidemiology and Clinical Research, Faculty of Medicine, University of New South Wales, Sydney, Australia. Dwilson@nchecr.unsw.edu.au
David P
DP
Wilson
Paul M
PM
Coplan