A once daily pill to prevent HIV infection could significantly reduce the spread of the AIDS-causing virus. However it would only be cost-effective if limited to men at very high risk for HIV infection, according to a new study.
Stanford University researchers created an economic model to analyze the use of the combination drug tenofovir-emtricitabine (brand name Truvada). A clinical trial found that the drug reduced a person's risk of HIV infection by an average of 44 percent when taken daily. In some people, the drug reduced the risk by 73 percent. But the drug is expensive -- $26 a day, or $10,000 a year. The economic model focused on men who have sex with men, a group that accounts for more than of the 56,000 new HIV infections a year in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC).
The researchers found that giving the pill to all U.S. men who have sex with men would cost $495 billion over 20 years, compared to $85 billion if the pill was given only to gay men at particularly high risk for HIV infection - those who have five or more sexual partners in a year.
The researchers find that without the use of the anti-HIV pill, there would be more than 490,000 new HIV infections among gay men in the United States over the next 20 years. If 20 percent of men who have sex with men took the pill daily, there would be nearly 63,000 fewer infections over the next 20 years. If 20 percent of high-risk gay men took the pill, there would be 41,000 fewer infections over 20 years. The study is in the April 17 issue of Annals of Internal Medicine.
Giving the pill to high-risk gay men represents good value, according to study first author Jessie Juusola, a Ph.D. candidate in management science and engineering in the School of Engineering at Stanford University. “However, even though it provides good value, it is still very expensive,” she said in a university news release. “In the current health-care climate, (these) costs may become prohibitive, especially given the other competing priorities for HIV resources, such as providing treatment for infected individuals.”
Since 2010, when a landmark study in the New England Journal of Medicine found that giving a daily dose of Gilead Sciences' Truvada to men who have sex with men can reduce HIV infection rates, researchers have been trying to work out how to make this treatment approach financially feasible. Clinical trials are under way to assess the drug's effectiveness when it is used less often than once a day.
Gilead is seeking permission for Truvada to be used as a form of “pre-exposure prophylaxis”. An FDA advisory panel is expected to consider in mid-May whether to allow use of the drug as a way to prevent HIV infection in healthy people.
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