A new paper published in Annals of Internal Medicine has found that the efficacy of the long-acting injectable HIV prevention medication cabotegravir (CAB-LA) is better than oral PrEP medication but the higher price needs to be justified, according to Contagion Live.
Researchers at Massachusetts General Hospital (MGH) used a simulation model to identify the greatest possible price differential that society should accept for the additional benefits of CAB-LA over oral PrEP.
In the model, the researchers used four strategies – no PrEP, daily oral emtricitabine/tenofovir disoproxil fumarate (F/TDF), branded emtricitabine–tenofovir alafenamide (F/TAF), and CAB-LA.
The 10-year model also included the costs of HIV care and PrEP and incremental cost-effectiveness ratios to determine the highest price that CAB-LA could command, according to Contagion Live. With this known, they determined that the QALY [quality-adjusted life-years] threshold would vary from $50,000 to $300,000 per QALY.
Compared to oral PrEP, CAB-LA demonstrated a reduction in HIV infections, with similar results in a US-based subset. These findings and the fact that the price of CAB-LA remained unknown prompted the researchers to determine the possibility of drug resistance among people who were prescribed PrEP.
The author found that total primary transmissions were higher in the no PrEP group, lower in the F/TDF and F/TAF groups, and lowest in the CAB-LA group.
Study author Dr. Anne Neilan told Contagion, “Oral PrEP costs about $1/day, or $360/year, which in turn meant that CAB-LA priced at $20,000 could not be considered to provide a good value.”
The investigators found that costs over 10 years would total $33.48 billion for no PrEP, $30 billion for generic F/TDF, $60 billion for F/TAF, and $75 billion for CAB-LA.
“It’s a remarkable advancement that HIV can now be prevented with one pill, once a day, for $1 a day, and treated, also with one pill, once a day,” said Dr. Neilan, who is an infectious disease expert at MGH.
“The key issue is to make sure that all adults, young and old, get tested for HIV, to incorporate PrEP into routine discussions about sexual health, and to prescribe PrEP for who are at increased HIV risk, or antiretroviral therapy if they have HIV,” she added. “That is how we can end the HIV epidemic in the United States and elsewhere.”
