Cost-effectiveness of tenofovir gel in urban South Africa: Model projections of HIV impact and threshold product prices

Fern Terris-Prestholt, Anna M. Foss, Andrew P. Cox, Lori Heise, Gesine Meyer-Rath, Sinead Delany-Moretlwe, Thomas Mertenskoetter, Helen Rees, Peter Vickerman, Charlotte H. Watts

Research output: Contribution to journalArticle

Abstract

Background: There is urgent need for effective HIV prevention methods that women can initiate. The CAPRISA 004 trial showed that a tenofovir-based vaginal microbicide had significant impact on HIV incidence among women. This study uses the trial findings to estimate the population-level impact of the gel on HIV and HSV-2 transmission, and price thresholds at which widespread product introduction would be as cost-effective as male circumcision in urban South Africa.Methods: The estimated 'per sex-act' HIV and HSV-2 efficacies were imputed from CAPRISA 004. A dynamic HIV/STI transmission model, parameterised and fitted to Gauteng (HIV prevalence of 16.9% in 2008), South Africa, was used to estimate the impact of gel use over 15 years. Uptake was assumed to increase linearly to 30% over 10 years, with gel use in 72% of sex-acts. Full economic programme and averted HIV treatment costs were modelled. Cost per DALY averted is estimated and a microbicide price that equalises its cost-effectiveness to that of male circumcision is estimated.Results: Using plausible assumptions about product introduction, we predict that tenofovir gel use could lead to a 12.5% and 4.9% reduction in HIV and HSV-2 incidence respectively, by year 15. Microbicide introduction is predicted to be highly cost-effective (under $300 per DALY averted), though the dose price would need to be just $0.12 to be equally cost-effective as male circumcision. A single dose or highly effective (83% HIV efficacy per sex-act) regimen would allow for more realistic threshold prices ($0.25 and $0.33 per dose, respectively).Conclusions: These findings show that an effective coitally-dependent microbicide could reduce HIV incidence by 12.5% in this setting, if current condom use is maintained. For microbicides to be in the range of the most cost-effective HIV prevention interventions, product costs will need to decrease substantially.

Original languageEnglish (US)
Article number14
JournalBMC infectious diseases
Volume14
Issue number1
DOIs
StatePublished - Jan 9 2014

Keywords

  • ARV-based prevention
  • Cost-effectiveness
  • Economic analysis
  • HIV
  • Introduction of new technologies
  • Microbicides
  • Modelling
  • Pre-exposure prophylaxis (PreP)
  • South Africa
  • Tenofovir

ASJC Scopus subject areas

  • Infectious Diseases

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    Terris-Prestholt, F., Foss, A. M., Cox, A. P., Heise, L., Meyer-Rath, G., Delany-Moretlwe, S., Mertenskoetter, T., Rees, H., Vickerman, P., & Watts, C. H. (2014). Cost-effectiveness of tenofovir gel in urban South Africa: Model projections of HIV impact and threshold product prices. BMC infectious diseases, 14(1), [14]. https://doi.org/10.1186/1471-2334-14-14