TY - JOUR
T1 - Cost-effectiveness of tenofovir gel in urban South Africa
T2 - Model projections of HIV impact and threshold product prices
AU - Terris-Prestholt, Fern
AU - Foss, Anna M.
AU - Cox, Andrew P.
AU - Heise, Lori
AU - Meyer-Rath, Gesine
AU - Delany-Moretlwe, Sinead
AU - Mertenskoetter, Thomas
AU - Rees, Helen
AU - Vickerman, Peter
AU - Watts, Charlotte H.
N1 - Funding Information:
The Bill & Melinda Gates Foundation provided grant support for some of the activities described in this paper. This research project was conducted in conjunction with the International Partnership for Microbicides (IPM), funded by the European Union, and contributes to the Microbicides Development Programme (MDP). MDP is a partnership of African and European academic/ government institutions and commercial organisations. MDP is funded by the British Government Department for International Development (DfID) and the UK Medical Research Council. AF, FTP, AC, PV, GMR and CW were also members of the DfID Research Programme Consortium for Research and Capacity Building in Sexual and Reproductive Health and HIV in Developing Countries of the LSHTM.
PY - 2014/1/9
Y1 - 2014/1/9
N2 - 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.
AB - 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.
KW - ARV-based prevention
KW - Cost-effectiveness
KW - Economic analysis
KW - HIV
KW - Introduction of new technologies
KW - Microbicides
KW - Modelling
KW - Pre-exposure prophylaxis (PreP)
KW - South Africa
KW - Tenofovir
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U2 - 10.1186/1471-2334-14-14
DO - 10.1186/1471-2334-14-14
M3 - Article
C2 - 24405719
AN - SCOPUS:84892188124
SN - 1471-2334
VL - 14
JO - BMC infectious diseases
JF - BMC infectious diseases
IS - 1
M1 - 14
ER -