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Table 1 Benefits and costs of expanding PrEP coverage and earlier ART strategies over 20 years

From: The cost-effectiveness of oral HIV pre-exposure prophylaxis and early antiretroviral therapy in the presence of drug resistance among men who have sex with men in San Francisco

Strategy Total new Infectionsa Total infections prevented (fraction)a New infections with drug-resistant strainsa Drug-resistant infections prevented (fraction)a HIV prevalence in 2038 (%) Total costs of PrEP (million US $)b,c Total costs (million US $)c Total QALYsc Incremental costs (million US $)d Incremental QALYsd ICER relative to the status quo ICER relative to next best strategy
Status quo (Low PrEP coverage) 44,508 18,426 9.26 5648 9189 1,315,057
Medium PrEP coverage 30,710 13,798 (31%) 14,685 3741 (20%) 5.67 11,577 14,666 1,361,814 5477 46,757 117,130 Dominatede
High PrEP coverage 21,370 23,138 (52%) 11,487 6939 (38%) 3.81 18,056 20,773 1,402,468 11,584 87,411 132,520 Dominatede
Low PrEP coverage+Earlier ART 34,808 9700 (22%) 16,969 1457 (8%) 7.43 5914 9396 1,358,706 207 43,649 4745 4745
Medium PrEP coverage+Earlier ART 25,892 18,616 (42%) 13,686 4740 (26%) 5.14 11,905 15,025 1,389,105 5836 74,048 78,811 185,160
High PrEP coverage+Earlier ART 19,093 25,414 (57%) 10,867 7559 (41%) 3.74 18,307 21,098 1,418,327 11,909 103,270 115,320 207,830
  1. PrEP pre-exposure prophylaxis, ART antiretroviral therapy, ICER incremental cost-effectiveness ratio, QALY quality-adjusted life-year
  2. aTotal new infections, new drug-resistant infections, total HIV infections prevented and drug-resistant infections prevented are undiscounted number from 2018 to 2038
  3. bIncludes the costs of antiretroviral drugs for PrEP, laboratory fees (such as HIV antibody test fee every 2–3 months, test fee for sexually transmitted infections every 6 months) and professional fees (such as visiting and consulting fees) [54]
  4. cCosts and quality-adjusted life years (QALYs) are net present values (3% annual discount rate) over 20 years
  5. dIncremental costs and QALYs are relative to the status quo
  6. eThe strategy that is dominated yields fewer QALYs at higher costs than the comparator and thus is not an effcient use of resources