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. 2018 Mar;21(3):e25064.
doi: 10.1002/jia2.25064.

The cost-effectiveness of multi-purpose HIV and pregnancy prevention technologies in South Africa

Matthew Quaife  1   2 , Fern Terris-Prestholt  1 , Robyn Eakle  1   2 , Maria A Cabrera Escobar  2 , Maggie Kilbourne-Brook  3 , Mercy Mvundura  3 , Gesine Meyer-Rath  4   5 , Sinead Delany-Moretlwe  2 , Peter Vickerman  6
Affiliations

The cost-effectiveness of multi-purpose HIV and pregnancy prevention technologies in South Africa

Matthew Quaife et al. J Int AIDS Soc. 2018 Mar.

Abstract

Introduction: A number of antiretroviral HIV prevention products are efficacious in preventing HIV infection. However, the sexual and reproductive health needs of many women extend beyond HIV prevention, and research is ongoing to develop multi-purpose prevention technologies (MPTs) that offer dual HIV and pregnancy protection. We do not yet know if these products will be an efficient use of constrained health resources. In this paper, we estimate the cost-effectiveness of combinations of candidate multi-purpose prevention technologies (MPTs), in South Africa among general population women and female sex workers (FSWs).

Methods: We combined a cost model with a static model of product impact based on incidence data in South Africa to estimate the cost-effectiveness of five candidate co-formulated or co-provided MPTs: oral PrEP, intravaginal ring, injectable ARV, microbicide gel and SILCS diaphragm used in concert with gel. We accounted for the preferences of end-users by predicting uptake using a discrete choice experiment (DCE). Product availability and protection were systematically varied in five potential rollout scenarios. The impact model estimated the number of infections averted through decreased incidence due to product use over one year. The comparator for each scenario was current levels of male condom use, while a health system perspective was used to estimate discounted lifetime treatment costs averted per HIV infection. Product benefit was estimated in disability-adjusted life years (DALYs) averted. Benefits from contraception were incorporated through adjusting the uptake of these products based on the DCE and through estimating the costs averted from avoiding unwanted pregnancies. We explore the additional impact of STI protection through increased uptake in a sensitivity analysis.

Results: At central incidence rates, all single- and multi-purpose scenarios modelled were cost-effective among FSWs and women aged 16-24, at a governmental willingness-to-pay threshold of $1175/DALY averted (range: $214-$810/DALY averted among non-dominant scenarios), however, none were cost-effective among women aged 25-49 (minimum $1706/DALY averted). The cost-effectiveness of products improved with additional protection from pregnancy. Estimates were sensitive to variation in incidence assumptions, but robust to other parameters.

Conclusions: To the best of our knowledge, this is the first study to estimate the cost-effectiveness of a range of potential MPTs; suggesting that MPTs will be cost-effective among higher incidence FSWs or young women, but not among lower incidence older women. More work is needed to make attractive MPTs available to potential users who could use them effectively.

Keywords: HIV prevention; South Africa; discrete choice experiments; key populations; multi-purpose prevention; pre-exposure prophylaxis.

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Figures

Figure 1
Figure 1
Modelling schematic.
Figure 2
Figure 2
Product uptake by group.
Figure 3
Figure 3
DALYs averted by population, scenario, and incidence assumption. Coloured bars represent DALYS averted at central incidence estimates, with upper and lower incidence assumptions indicated for each scenario. Populations presented separately due to scale differences in small FSW population.
Figure 4
Figure 4
Average cost per DALY averted by scenario and incidence assumption. Nb. Negative ICERs among FSWs are cost‐saving and DALY increasing interventions with a positive impact.
Figure 5
Figure 5
One‐way sensitivity analysis on incidence assumptions.
Figure 6
Figure 6
One‐way sensitivity analyses of scenario 1.
Figure 7
Figure 7
Cost‐effectiveness acceptability curves.
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References

    1. Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O'Reilly KR, Koechlin FM, et al. Effectiveness and safety of oral HIV pre‐exposure prophylaxis (PrEP) for all populations: A systematic review and meta‐analysis. AIDS. 2016;30(12):1973–83. - PMC - PubMed
    1. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre‐exposure prophylaxis to prevent the acquisition of HIV‐1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open‐label randomised trial. Lancet. 2016;387(10013):53–60. - PMC - PubMed
    1. Molina J‐M, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On‐demand preexposure prophylaxis in men at high risk for HIV‐1 infection. N Engl J Med. 2015;373(23):2237–46. - PubMed
    1. Nel A, Kapiga S, Bekker L‐G, Devlin B, Borremans M, Rosenberg Z, et al. Safety and Efficacy of Dapivirine Vaginal Ring for HIV‐1 Prevention in African Women. CROI 2016; Seattle, USA 2016.
    1. Baeten JM, Palanee‐Phillips T, Brown ER, Schwartz K, Soto‐Torres LE, Nel A, et al. A Phase III Trial of the Dapivirine Vaginal Ring for HIV‐1 Prevention in Women. Conference on Retroviruses and Opportunistic Infections Boston, MA 2016.

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