Cost Effectiveness of PrEP Intervention

The World Health Organization (WHO) recommends pre-exposure prophylaxis (PrEP) among the population at substantially HIV risk. Despite many randomized controlled trials illustrating efficacy of the intervention, and many intervention being carried out, only few countries have embraced PrEp as a preventative care (WHO, 2012). WHO has released many position statements recommending PrEP among people at high risk of contracting HIV. The daily use of oral Truvada among HIV negative people was approved in the USA in 2012 (WHO, 2012). However, many countries including Australia and Europe have not allowed PrEP intervention. Modelling studies are believed to be the best approach in unearthing the long-term impact of PrEP intervention among different population groups (WHO 2012). Scholars have heavily documented the cost of introducing PrEP and its cost effectiveness in various countries. Despite its slow uptake in many countries, PrEP is a cost effective intervention against HIV.

Recent studies have illustrated that among men having sex with men (MSM) in North America, PrEP cost saving ranges to costing US $160 000/quality-adjusted life-year gained (QALYS) (Ouellet, Durand, Guertin et al., 2015). In a report from Africa that documented heterosexual sero-different couples, the figures varied from US $5000 to US $10 000/disability adjusted life-year averted. In the report, PrEP was implemented 6 or 12 months after the HIV-positive partner had rolled out antiretroviral therapy (ART) in Uganda and South Africa, respectively (Ying, Sharma, Heffron et al, 2015). Other administrative cost factors as well influence the financial inputs.

A systematic literature review demonstrates varying cost effectiveness of PrEP intervention based on the economic region targeted. Table 1, summarizes studies finding by various scholars. Seven studies were considered for this report, among them, 3 were heterosexual sero-different couples, three were MSM, and one was among general population who attended general clinic. The SMS population included people from Lose Angeles and Canada, while sero-couples were collected from Africa: Uganda, South Africa, and Nigeria. This paper focuses on five cost-effective studies comparing PrEP intervention situations and areas PrEP was not administered.

            Chen and Dowdy and Ouellet et al. assumed cost effectiveness of PrEP against HIV as 44%, from the IPrEx study that was conducted among MSM in various countries including the USA: 92% in a different scenario (Chen et al., 2014), 70% with a range of 44 and 90% (Mitchell et al., 2015), 90% (Jewell et al, 2015), and 92% with a range of 77–98% by (Ying et al, 2015). All the statistics demonstrated PrEP cost-effectiveness.

The cost of PrEP intervention varied significantly per setting. In South Africa and Nigeria, it was estimated at $250 a year (Mitchell, Terris-Prestholt, Torpey et al, 2015). In Uganda it was $408 in the study. The Ugandan figures dropped to $92 in the government setting (Ying, Sharma, Heffron et al. 2015). In North America, it was estimated at $10 000 per year. The figures ranged from $5000–$15 000, including the cost of renal function tests before PrEP initiation, detailing HIV-negative status, HIV screening, quarterly clinic visits, biannual STD and STI screenings, and biannual renal function tests  (Chen et al, 2014). The costs involve varied with setting.

Three studies considered the societal perspective cost benefits of PrEP interventions. Costs such as direct medical, nonmedical costs (transportation), indirect costs (work time lost), and intangible costs (pain and suffering) (Chen et al., 2014). One included healthcare system perspective and two the provider perspective (Ouellet, Durand, Guertin et al., 2015). The MSM in North America also included a lifetime horizon (Chen et al., 2014). On the other hand, the sero-different couples in South Africa and Nigeria adopted a time horizon of 20 years (Ouellet, Durand, Guertin et al, 2015) and the Ugandan study used 10 years (Ying, Sharma, Heffron et al. 2015). All the studies discounted the costs and effects through annual discount rate of 3% per year (Ying, Sharma, Heffron et al., 2015) except Mitchell et al. (2014) that adopted annual discount rate of 10% per year, due to high predilection in Nigeria.

Table 1: Prep Cost-Effectiveness ((Ouellet, Durand, Guertin et al., 2015).

The studies illustrated that PrEP intervention as compared to none PrEP intervention proved more cost effectiveness. Evidently, offering PrEP to population subgroups for periods of time when they are at high risk, comes with many cost advantages. PrEP interventions have proved more cost effective than non-PrEP intervention situations.


Chen, A., Dowdy, DW. (2014). Clinical Effectiveness and cost-effectiveness of HIV preexposure prophylaxis in men who have sex with men: Risk calculators for real world decision-making. PLoS One, 9:e108742.

Jewell, B., Cremin, I., Pickles, M., et al. (2015). Estimating the cost-effectiveness of preexposure prophylaxis to reduce HIV-1 and HSV-2 incidence in HIV-sero-discordant couples in South Africa. PLoS One, 10:0115511.

Mitchell, K., Terris-Prestholt, F., Torpey, K., et al. (2015). Modelling the impact and cost- effectiveness of combination prevention amongst HIV sero-discordant couples in Nigeria.   AIDS, 29:2035–2044.

Ouellet, E., Durand, M., Guertin, JR. et al. (2015). Cost effectiveness of ’on demand’ HIV preexposure prophylaxis for noninjection drug-using men who have sex with men in Canada. Can J Infect Dis Med Microbiol, 26:23–29.

WHO. (2012). Guidance on Pre-Exposure oral Prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV: Recommendations for use in the context of demonstration projects. Geneva Switzerland: World Health Organization.

Ying, R., Sharma, M., Heffron, R. et al. (2015). Cost-effectiveness of preexposure prophylaxis targeted to high-risk sero-discordant couples as a bridge to sustained ART use in Kampala, Uganda. J Int AIDS Soc, 18:21–29