The “unrealistic” pricing of long-acting injectable PrEP hinders its use where HIV control budgets are stretched, according to researchers, who found that event-driven oral PrEP is a more cost-effective option for fixed budgets.
Long-acting injectable cabotegravir (CAB-LA) — the first FDA-approved long-acting injectable PrEP — is highly effective and could potentially prevent the most HIV infections globally but is significantly more expensive than oral tenofovir/emtricitabine (TDF/FTC), which limits its potential use, Ishani Sharma, a researcher at the Imperial College London School of Medicine, and Andrew Hill, PhD, senior visiting research fellow at the University of Liverpool, wrote in a study published in Clinical Infectious Diseases.
Sharma and Hill analyzed 98 studies that included 5,230,189 people in 33 countries, evaluating HIV infection rates for five prevention strategies — no PrEP, continuous CAB-LA ($22,200 per person per year), continuous CAB-LA at its target price ($250 per person per year), continuous TDF/FTC ($48 per person per year) and event-driven TDF/FTC ($12 per person per year).
Based on the studies, the researchers determined mean HIV incidence at 2.6 per 100 person-years. The number of people needed to treat to prevent one infection (NNTB) was 42.7 for CAB-LA and 64.1 for continuous and event-driven TDF/FTC.
They estimated that, at the current price, it would cost $949,487 to prevent one HIV infection using continuous CAB-LA, which is more than the annual PrEP budgets for many countries, including some of the top-spending low- and middle-income countries, the researchers noted.
The cost to prevent one infection was $11,453 for CAB-LA at its target price, $4,231 for continuous TDF/FTC and $1,923 for event-driven TDF/FTC.
Based on the analysis, the researchers said event-driven TDF/FTC should be evaluated for wider use to maximize HIV prevention.
“CAB-LA is the most efficacious form of PrEP, but high prices limit numbers who can be treated,” Sharma and Hill wrote. “More HIV infections can be prevented using low-cost, event-driven TDF/FTC as PrEP: far more people can be treated for fixed budgets. This result was consistent across a range of at-risk populations in different countries.”
ViiV Healthcare last year did sign an agreement to allow manufacturing of generic versions of CAB-LA in 90 countries.
By Stephen Feller
Source : Healio
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