Cost Utility Analysis of HIV Pre Exposure Prophylaxis among Men who have Sex with Men in Israel

Background: Between 2011-2015, Men who have sex with men (MSM) accounted for nearly half of new HIV cases among men in Israel. This study carries out a cost-utility analysis of PrEP (HIV Pre Exposure Prophylaxis), an antiretroviral medication that can protect against the acquisition of HIV infection, which can lead to AIDS.

Method: Epidemiological, demographic, health service utilisation and economic data were integrated into a spread-sheet model in order to calculate the cost per averted disability-adjusted life year (DALY) of the intervention from a societal perspective. Cost Utility Analyses were performed for both types of PrEP delivery (continuous regimen and on-demand), together with several sensitivity analysis.

Results: Offering PrEP to the 21.3% of MSMs (who are high risk) would have a ten year net cost of around 5,621 million NIS (NEW Israeli Shekels) and prevent 493 persons from becoming HIV positive, averting around 1,616 DALYs at a cost per averted DALY of around 3.48 million NIS. This will render the intervention to be not cost-effective. PrEP drug prices would have to fall dramatically (by 90.7%) for the intervention to become cost-effective in Israel. PrEP remains not cost effective (at 1,71 million NIS per averted DALY) even if intervention costs were reduced by using an “on demand” instead of a daily schedule Even if there were no changes in condom use, the resultant 1.48 million NIS cost-utility ratio is still not cost effective.

Conclusions: PrEP was found not to be cost-effective in the Israeli context. This is not because PrEP is ineffective against HIV, but because of a combination of relatively low incidence, and high cost of the drugs, together with the high probability that many low-risk MSM (ie: who use condoms) may well begin taking PrEP and some of these will abandon condom use. Therefore, ways of minimizing these phenomena, need to be found.