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

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

Strategy	Total new Infections^a	Total infections prevented (fraction)^a	New infections with drug-resistant strains^a	Drug-resistant infections prevented (fraction)^a	HIV prevalence in 2038 (%)	Total costs of PrEP (million US $)^b,c	Total costs (million US $)^c	Total QALYs^c	Incremental costs (million US $)^d	Incremental QALYs^d	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	Dominated^e
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	Dominated^e
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

PrEP pre-exposure prophylaxis, ART antiretroviral therapy, ICER incremental cost-effectiveness ratio, QALY quality-adjusted life-year
^aTotal new infections, new drug-resistant infections, total HIV infections prevented and drug-resistant infections prevented are undiscounted number from 2018 to 2038
^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]
^cCosts and quality-adjusted life years (QALYs) are net present values (3% annual discount rate) over 20 years
^dIncremental costs and QALYs are relative to the status quo
^eThe strategy that is dominated yields fewer QALYs at higher costs than the comparator and thus is not an effcient use of resources

ISSN: 1741-7015