COST EFFECTIVENESS ANALYSIS OF LENACAPAVIR COMPARED TO CABOTEGRAVIR AND GENERIC ORAL FTC/TDF FOR HIV PREEXPOSURE PROPHYLAXIS AMONG CIS-GENDER WOMEN IN THE UNITED STATES
Author(s)
Devyani Bhatnagar, MS1, Prajakta P. Masurkar, PhD2, Swarnali Goswami, PhD3, David W. Hutton, PhD4;
1University of Michigan, Ann Arbor, MI, USA, 2UCB, HEOR, Milton, GA, USA, 3Neurocrine Biosciences, Inc., HEOR, San Diego, CA, USA, 4University of Michigan, Department of Health Management and Policy,, Ann Arbor, MI, USA
1University of Michigan, Ann Arbor, MI, USA, 2UCB, HEOR, Milton, GA, USA, 3Neurocrine Biosciences, Inc., HEOR, San Diego, CA, USA, 4University of Michigan, Department of Health Management and Policy,, Ann Arbor, MI, USA
OBJECTIVES: To estimate lifetime cost-effectiveness of long-acting lenacapavir(LEN-LA) versus cabotegravir(CAB-LA) and daily oral generic emtricitabine/tenofovir disoproxil fumarate(FTC/TDF) for HIV prevention from US payer perspective.
METHODS: A four-state Markov model simulated PrEP initiation with CAB-LA, LEN-LA, or FTC/TDF in eligible adults over 40-year time horizon, with health states including uninfected on PrEP, uninfected off PrEP, HIV-infected, and dead. Individuals could continue initial PrEP or discontinue. Efficacy data were drawn from HPTN 083/084 trials for CAB-LA, FTC/TDF and PURPOSE 1 trial for LEN-LA. Additional model inputs were obtained from published literature. Lifetime HIV-related costs, transmissions, and resistance risks were modeled. Primary outcomes included incremental cost-effectiveness ratio(ICER) per quality-adjusted life-years (QALY) at willingness-to-pay threshold(WTP) of $100,000. All outcomes were discounted at 3%. One-way and probabilistic sensitivity analyses(PSA) were performed to assess model robustness.
RESULTS: All three PrEP strategies demonstrated comparable HIV prevention effectiveness. Both CAB-LA and LEN-LA reduced QALY losses versus FTC/TDF, with incremental lifetime costs of $54,980.72 and $60,501.75 per person, respectively. oral FTC/TDF remained most cost-effective option. Among injectables, LEN-LA was more cost-effective than CAB-LA, with an ICER of $49,971 per QALY gained. Compared to oral FTC/TDF, LEN-LA’s ICER was $384,572 per QALY exceeding WTP. While LEN-LA offers better value among long-acting options, both injectable strategies were not cost-effective compared to oral FTC/TDF. Results were robust across sensitivity analyses. One-way sensitivity analyses identified drug costs and HIV care costs as key drivers of ICER for LEN-LA vs. CAB-LA, while persistence on PrEP was most influential in comparisons between LEN-LA and FTC/TDF.
CONCLUSIONS: While LEN-LA is more cost-effective than CAB-LA, its high cost makes it less cost-effective than daily oral FTC/TDF at current prices. LEN-LA may benefit populations with poor oral PrEP adherence, but broad adoption may not be economically justified without price reductions. Findings inform value-based formulary decision-making to support patient-centered and equitable PrEP access
METHODS: A four-state Markov model simulated PrEP initiation with CAB-LA, LEN-LA, or FTC/TDF in eligible adults over 40-year time horizon, with health states including uninfected on PrEP, uninfected off PrEP, HIV-infected, and dead. Individuals could continue initial PrEP or discontinue. Efficacy data were drawn from HPTN 083/084 trials for CAB-LA, FTC/TDF and PURPOSE 1 trial for LEN-LA. Additional model inputs were obtained from published literature. Lifetime HIV-related costs, transmissions, and resistance risks were modeled. Primary outcomes included incremental cost-effectiveness ratio(ICER) per quality-adjusted life-years (QALY) at willingness-to-pay threshold(WTP) of $100,000. All outcomes were discounted at 3%. One-way and probabilistic sensitivity analyses(PSA) were performed to assess model robustness.
RESULTS: All three PrEP strategies demonstrated comparable HIV prevention effectiveness. Both CAB-LA and LEN-LA reduced QALY losses versus FTC/TDF, with incremental lifetime costs of $54,980.72 and $60,501.75 per person, respectively. oral FTC/TDF remained most cost-effective option. Among injectables, LEN-LA was more cost-effective than CAB-LA, with an ICER of $49,971 per QALY gained. Compared to oral FTC/TDF, LEN-LA’s ICER was $384,572 per QALY exceeding WTP. While LEN-LA offers better value among long-acting options, both injectable strategies were not cost-effective compared to oral FTC/TDF. Results were robust across sensitivity analyses. One-way sensitivity analyses identified drug costs and HIV care costs as key drivers of ICER for LEN-LA vs. CAB-LA, while persistence on PrEP was most influential in comparisons between LEN-LA and FTC/TDF.
CONCLUSIONS: While LEN-LA is more cost-effective than CAB-LA, its high cost makes it less cost-effective than daily oral FTC/TDF at current prices. LEN-LA may benefit populations with poor oral PrEP adherence, but broad adoption may not be economically justified without price reductions. Findings inform value-based formulary decision-making to support patient-centered and equitable PrEP access
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE494
Topic
Economic Evaluation
Topic Subcategory
Novel & Social Elements of Value, Trial-Based Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Reproductive & Sexual Health, STA: Vaccines