COST-EFFECTIVENESS OF LENACAPAVIR VERSUS ORAL AND INJECTABLE PREP OPTIONS FOR HIV PREVENTION IN THE UNITED STATES
Author(s)
JEANPIERRE COAQUIRA CASTRO, MPH1, David Cameron, MSc2, Alice Hsiao, PharmD1, Kirk Szafranski, MSc2, James Class, PhD1, Meghan Watson, MSc2, Patrick Sullivan, DVM, PhD3;
1Gilead Sciences, Inc., Foster City, CA, USA, 2EVERSANA, Burlington, ON, Canada, 3Emory University, Atlanta, GA, USA
1Gilead Sciences, Inc., Foster City, CA, USA, 2EVERSANA, Burlington, ON, Canada, 3Emory University, Atlanta, GA, USA
OBJECTIVES: Pre-exposure prophylaxis (PrEP) is critical for public health efforts in preventing HIV; current PrEP options include daily oral tablets, every-two-month injectable cabotegravir (CAB), and twice-yearly injectable lenacapavir (LEN). The PURPOSE-1 and PURPOSE-2 trials demonstrated superior efficacy of LEN versus oral PrEP at preventing HIV among cisgender women (CGW), men-who-have-sex-with-men (MSM), and gender-diverse persons. This analysis evaluated the cost-effectiveness of LEN versus oral PrEP and CAB for HIV prevention among diverse US populations.
METHODS: A Markov model was developed to simulate HIV acquisition and treatment persistence over a 50-year time horizon from a US healthcare payer perspective, using quarter-year cycles and 3% discounting. The model incorporated clinical inputs from PURPOSE-1, PURPOSE-2, HPTN 083, and HPTN 084 trials. Onward transmissions were included, parameterized using a literature-informed transmission multiplier or dynamic risk module. Costs included: drug acquisition/administration, monitoring, HIV testing, adverse events, HIV infection, and mortality. MSM (including gender-diverse persons) and CGW populations were modeled separately, with results presented disaggregated and as a weighted average total.
RESULTS: In MSM and CGW, LEN strongly dominated CAB and oral PrEP, producing more quality-adjusted life years (QALYs) and life years (LYs) at lower cost. Weighted incremental LYs and QALYs were 0.24 and 0.38 versus oral PrEP and 0.05 and 0.07 versus CAB, respectively. Cost savings were $24,467 versus generic oral PrEP and $6,606 versus CAB. Scenarios exploring subgroups, time horizon, discount rate, and patient age found similar results. Scenarios using the upper bound of the 95% confidence interval for HIV incidence for LEN and CAB found that LEN was still dominant.
CONCLUSIONS: LEN resulted in more QALYs and LYs at lower costs than other PrEP options, including CAB, supporting LEN as the dominant strategy. These findings may inform payers and population health and policy decision makers regarding the value of twice-yearly LEN adoption in populations who benefit from PrEP.
METHODS: A Markov model was developed to simulate HIV acquisition and treatment persistence over a 50-year time horizon from a US healthcare payer perspective, using quarter-year cycles and 3% discounting. The model incorporated clinical inputs from PURPOSE-1, PURPOSE-2, HPTN 083, and HPTN 084 trials. Onward transmissions were included, parameterized using a literature-informed transmission multiplier or dynamic risk module. Costs included: drug acquisition/administration, monitoring, HIV testing, adverse events, HIV infection, and mortality. MSM (including gender-diverse persons) and CGW populations were modeled separately, with results presented disaggregated and as a weighted average total.
RESULTS: In MSM and CGW, LEN strongly dominated CAB and oral PrEP, producing more quality-adjusted life years (QALYs) and life years (LYs) at lower cost. Weighted incremental LYs and QALYs were 0.24 and 0.38 versus oral PrEP and 0.05 and 0.07 versus CAB, respectively. Cost savings were $24,467 versus generic oral PrEP and $6,606 versus CAB. Scenarios exploring subgroups, time horizon, discount rate, and patient age found similar results. Scenarios using the upper bound of the 95% confidence interval for HIV incidence for LEN and CAB found that LEN was still dominant.
CONCLUSIONS: LEN resulted in more QALYs and LYs at lower costs than other PrEP options, including CAB, supporting LEN as the dominant strategy. These findings may inform payers and population health and policy decision makers regarding the value of twice-yearly LEN adoption in populations who benefit from PrEP.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE232
Topic
Economic Evaluation
Disease
SDC: Infectious Disease (non-vaccine)