Potential population health outcomes and expenditures of HIV vaccination strategies in the United States

Abstract

Estimating the potential health benefits and expenditures of a partially effective HIV vaccine is an important consideration in the debate about whether HIV vaccine research should continue. We developed an epidemic model to estimate HIV prevalence, new infections, and the cost-effectiveness of vaccination strategies in the U.S. Vaccines with modest efficacy could prevent 300,000-700,000 HIV infections and save $30 billion in healthcare expenditures over 20 years. Targeted vaccination of high-risk individuals is economically efficient, but difficulty in reaching these groups may mitigate these benefits. Universal vaccination is cost-effective for vaccines with 50% efficacy and price similar to other infectious disease vaccines.

Figure 1

HIV infections prevented over 20 years with different vaccination strategies. (a) HIV infections prevented with universal, high-risk group targeted, or low-risk group targeted vaccination. Assumes a vaccine with 75% efficacy and lifetime duration of protection, and 75% coverage of the target population. (b) HIV infections prevented under different vaccine efficacy (25%, 50%, 75%, 100%) and duration (5-year, 10-year, lifetime) scenarios. Assumes universal vaccination (both high-risk and low-risk groups) with 75% coverage.

Figure 2

HIV prevalence in the six population risk groups under universal and high-risk group targeted vaccination strategies. Assumes a vaccine with 75% efficacy and lifetime duration, and 75% coverage of the target population. IDU = Injection drug user, MSM = Men who have sex with men, Other = General population.

Figure 3

Cost-effectiveness analysis of HIV vaccination over 20 years (a) Cost-effectiveness of universal, high-risk group targeted, or low-risk group targeted vaccination. Assumes a vaccine with 75% efficacy, lifetime duration of protection, and $1000 price, and 75% coverage of the target population. (b) Cost-effectiveness of universal vaccination under different vaccine efficacy (25%, 50%, 75%, 100%) and duration of protection (5-year, 10-year, lifetime) scenarios. Assumes a vaccine with $1000 price, and 75% coverage of the target population. Incremental cost-effectiveness ratios are relative to the status quo (no vaccination).