Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States, Cora L. Bernard, MS et al., Annals of Internal Medicine (2016)

Many trials have shown daily oral preexposure prophylaxis (PrEP) can prevent HIV transmission. PrEP treatment is expensive, however, costing $10,000 annually even without regular HIV screening and adverse effects assessment recommended by the CDC. This empirically calibrated model study examines the cost-effectiveness of expanding PrEP treatment to people who inject drugs (PWID), concluding PWID can optimize HIV pre- vention through a combination of PrEP, frequent screening, and anti- retroviral therapy for those infected. However, at current drug prices, this is an expensive intervention in both absolute terms and in cost per quality-adjusted life-years, or years in perfect health gained.  Additionally, the study reports significant limitations, that “efficacy depends on ad- herence,” and “[w]hether adherence in the United States would reach (or exceed) levels in the trial has not yet been demonstrated.”

PWID represent a large proportion of HIV sufferers in the U.S., composing less than one percent of the population but 10 percent of new HIV infections. As such, treatment and prevention methods focused on the PWID population serve a significant public health benefit.