title: The Potential Cost-Effectiveness of HIV Vaccines: A Systematic Review.
abstract: OBJECTIVE
  The aim of this paper was to review and compare HIV vaccine cost-effectiveness analyses and describe the effects of uncertainty in model, methodology, and parameterization.
  
  
  METHODS
  We systematically searched MEDLINE (1985 through May 2016), EMBASE, the Tufts CEA Registry, and reference lists of articles following Cochrane guidelines and PRISMA reporting. Eligibility criteria included peer-reviewed manuscripts with economic models estimating cost-effectiveness of preventative HIV vaccines. Two reviewers independently assessed study quality and extracted data on model assumptions, characteristics, input parameters, and outcomes.
  
  
  RESULTS
  The search yielded 71 studies, of which 11 met criteria for inclusion. Populations included low-income (n=7), middle-income (n=4), and high-income countries (n=2). Model structure varied including decision tree (n=1), Markov (n=5), compartmental (n=4), and microsimulation (n=1). Most measured outcomes in quality adjusted life-years (QALYs) gained (n=6) while others used unadjusted (n=3) or disability adjusted life-years (n=2). HIV vaccine cost ranged from $1.54 -$75 USD in low-income countries, $55-$100 in middle-income countries, and $500-$1,000 in the United States. Base case ICERs ranged from dominant (cost-offsetting) to $91,000 per QALY gained.
  
  
  CONCLUSIONS
  Most models predicted HIV vaccines would be cost-effective. Model assumptions about vaccine price, HIV treatment costs, epidemic context, and willingness to pay influenced results more consistently than assumptions on HIV transmission dynamics.
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Blythe
authors.initials: B
authors.lastname: Adamson
authors.affiliation: Virology and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Dobromir
authors.initials: D
authors.lastname: Dimitrov
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Devine
authors.affiliation: Virology and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Allergy and Infectious Diseases and Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Ruanne
authors.initials: R
authors.lastname: Barnabas