Department of Pharmacy, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA.
Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
J Int AIDS Soc. 2019 Aug;22(8):e25373. doi: 10.1002/jia2.25373.
Promising HIV vaccine candidates are steadily progressing through the clinical trial pipeline. Once available, HIV vaccines will be an important complement but also potential competitor to other biomedical prevention tools such as pre-exposure prophylaxis (PrEP). Accordingly, the value of HIV vaccines and the policies for rollout may depend on that interplay and tradeoffs with utilization of existing products. In this economic modelling analysis, we estimate the cost-effectiveness of HIV vaccines considering their potential interaction with PrEP and condom use.
We developed a dynamic model of HIV transmission among the men who have sex with men population (MSM), aged 15-64 years, in Seattle, WA offered PrEP and HIV vaccine over a time horizon of 2025-2045. A healthcare sector perspective with annual discount rate of 3% for costs (2017 USD) and quality-adjusted life years (QALYs) was used. The primary economic endpoint is the incremental cost-effectiveness ratio (ICER) when compared to no HIV vaccine availability.
HIV vaccines improved population health and increased healthcare costs. Vaccination campaigns achieving 90% coverage of high-risk men and 60% coverage of other men within five years of introduction are projected to avoid 40% of new HIV infections between 2025 and 2045. This increased total healthcare costs by $30 million, with some PrEP costs shifted to HIV vaccine spending. HIV vaccines are estimated to have an ICER of $42,473/QALY, considered cost-effective using a threshold of $150,000/QALY. Results were most sensitive to HIV vaccine efficacy and future changes in the cost of PrEP drugs. Sensitivity analysis found ranges of 30-70% HIV vaccine efficacy remained cost-effective. Results were also sensitive to reductions in condom use among PrEP and vaccine users.
Access to an HIV vaccine is desirable as it could increase the overall effectiveness of combination HIV prevention efforts and improve population health. Planning for the rollout and scale-up of HIV vaccines should carefully consider the design of policies that guide interactions between vaccine and PrEP utilization and potential competition.
有前途的 HIV 疫苗候选者正在临床试验管道中稳步推进。一旦可用，HIV 疫苗将是其他生物医学预防工具（如暴露前预防[PrEP]）的重要补充，也可能成为其潜在竞争者。因此，HIV 疫苗的价值及其推出政策可能取决于其与现有产品的利用之间的相互作用和权衡。在这项经济建模分析中，我们考虑到 HIV 疫苗与 PrEP 和 condom 使用的潜在相互作用，估计了 HIV 疫苗的成本效益。
我们为西雅图的男男性行为者（MSM）人群（年龄在 15-64 岁之间）开发了一种 HIV 传播的动态模型，该人群提供 PrEP 和 HIV 疫苗，时间范围为 2025-2045 年。使用医疗保健部门视角，每年对成本（2017 年美元）和质量调整生命年（QALYs）进行 3%的贴现率。主要的经济终点是与无 HIV 疫苗供应相比的增量成本效益比（ICER）。
HIV 疫苗改善了人群健康并增加了医疗保健成本。假设疫苗接种运动在引入后的五年内实现了 90%的高危男性和 60%的其他男性的疫苗接种覆盖率，预计在 2025 年至 2045 年期间将避免 40%的新 HIV 感染。这增加了 3000 万美元的总医疗保健成本，部分 PrEP 成本转移到 HIV 疫苗支出上。HIV 疫苗的 ICER 估计为 42473 美元/QALY，使用 150000 美元/QALY 的阈值被认为是具有成本效益的。结果对 HIV 疫苗的疗效和 PrEP 药物未来成本的变化最为敏感。敏感性分析发现，HIV 疫苗疗效在 30%-70%之间仍然具有成本效益。结果还对 PrEP 和疫苗使用者中 condom 使用减少的情况敏感。
获得 HIV 疫苗是可取的，因为它可以提高组合 HIV 预防措施的整体效果，改善人群健康。规划 HIV 疫苗的推出和扩大应仔细考虑指导疫苗和 PrEP 使用之间相互作用以及潜在竞争的政策设计。
