Anne Neilan, MD, MPH, investigator in the MGH Division of Pediatrics and General Infectious Diseases, who led the study.
“While a shot given every two months to prevent HIV is an interesting option unless priced to reflect its true value compared to the newly available conventional pills, those who need it be left behind.”
In collaboration with investigators from the HIV Prevention Trial Network (HPTN) 083 studied the efficacy of long-acting injectable cabotegravir (CAB-LA) compared with oral emtricitabine/tenofovir disoproxil fumarate (F/TDF) days in HIV pre-exposure prophylaxis between MSM/TGW.
Neilan and colleagues used a well-publicized computer micro-model to examine the cost-effectiveness of long-acting injectable PrEP compared with oral alternatives to MSM/TGW.
The analysis shows that at a range of willingness-to-pay thresholds ($50,000-$300,000/QALY), CAB-LA for PrEP in the high-risk MSM/TGW group for HIV will only offer good value if the annual price Its $6,600 higher than the generic F/TDF.
The price of CAB-LA was announced after the study was accepted for publication, and its annual price was more than three times higher than estimated in the study.
Kenneth Freedberg, MD, MSc, director of the MGH Center for Health Practice Evaluation and a co-author of the study, said: “Despite concerns that the evaluation of new products compares to competitors. General competition can limit innovation, but the value of a new drug should be measured by how much better it is than what is already available and how much people would be willing to pay for that improvement. .”
He added: “The current valuation of CAB-LA is likely to exacerbate existing disparities in PrEP reception, rather than ameliorate them.
“This has clear implications in the United States and is even more significant in lower-resource settings, where CAB-LA for PrEP is highly anticipated but has not yet been introduced.”
Adds Raphael J. Landovitz, MD, MSc, co-director of the UCLA Center for Clinical AIDS Education & Research, who led the HPTN 083 trial and study co-author: “In the US, CAB-LA may have the highest value and greatest utility in settings and for those who prescribed oral PrEP is challenging or impossible.”
The authors also highlight opportunities to improve performance if CAB-LA can be priced to save costs compared to conventional F/TDF.
Neilan adds: “Additional investments can be made in innovative delivery approaches that, in turn, will promote more equitable access to this novel preventive therapy. ”
This work was supported by FHI 360. The study received additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute of Allergy and Infectious Diseases; National Heart, Lung and Blood Institute; National Institute on Drug Abuse; Jerome and Celia Reich’s HIV Scholar Award; and the Steve and Deborah Gorlin MGH Research Scholar Award.
Source: Medindia
