IS LENACAPAVIR-BASED PREP AN EFFICIENT AND AFFORDABLE SOLUTION IN A FRENCH CONTEXT? A COST-UTILITY AND BUDGET IMPACT ANALYSIS
Author(s)
Guillaume Laubel, PharmD, MsC1, Ines Hemim, PharmD, MsC2.
1Université Rennes 1, Rennes, France, 2Université de Lyon, Lyon, France.
1Université Rennes 1, Rennes, France, 2Université de Lyon, Lyon, France.
OBJECTIVES: Pre-exposure prophylaxis (PrEP) uses antiretroviral therapy to prevent HIV infection in uninfected individuals. In France, it has been reimbursed since 2016, initially with emtricitabine/tenofovir. Cabotegravir became the second reimbursed PrEP option in early 2026. Lenacapavir, not yet available in France, could be the next subcutaneous injectable treatment covered by the national health insurance system.
METHODS: A Markov model was developed based on published models. Individuals entered the model in the “Eligible for PrEP” health state and were assumed to be HIV-negative at baseline. They could initiate PrEP according to French guidelines, receive lenacapavir as a first-line PrEP option, or discontinue PrEP, or transition to the “death” state. At each cycle, the probability of transitioning to the “HIV infection” state depended on the PrEP strategy received. Individuals. PrEP efficacy data was estimated from lenacapavir PURPOSE-2 trial. Costs were estimated according to HAS guidelines, and utility scores were derived from published literature. Cost-effectiveness analysis was conducted considering a life-time time horizon and has been subjected to deterministic probabilistic sensitivity and scenario analyses.
RESULTS: The base-case analysis and sensitivity analyses revealed a significant impact of the price of lenacapavir on the incremental cost-utility ratio (ICUR, in € per additional QALY), with a price-to-ICUR ratio calculated using the following formula: ICUR = 227.97x - 508,149; where x is the cost of double lenacapavir injection. An analysis assuming that the price of lenacapavir is the same as that of lenacapavir (SUNLENCA) showed a price difference of €386,119 compared to the standard strategy, and for a negligible gain in QALY (0,1 additional QALY).
CONCLUSIONS: The analysis showed that the cost-utility results for lenacapavir-based PrEP were primarily dependent on the assumed price of lenacapavir. PURPOSE-2 reported encouraging efficacy results, although its implementation in France still requires incorporation into national guidelines.
METHODS: A Markov model was developed based on published models. Individuals entered the model in the “Eligible for PrEP” health state and were assumed to be HIV-negative at baseline. They could initiate PrEP according to French guidelines, receive lenacapavir as a first-line PrEP option, or discontinue PrEP, or transition to the “death” state. At each cycle, the probability of transitioning to the “HIV infection” state depended on the PrEP strategy received. Individuals. PrEP efficacy data was estimated from lenacapavir PURPOSE-2 trial. Costs were estimated according to HAS guidelines, and utility scores were derived from published literature. Cost-effectiveness analysis was conducted considering a life-time time horizon and has been subjected to deterministic probabilistic sensitivity and scenario analyses.
RESULTS: The base-case analysis and sensitivity analyses revealed a significant impact of the price of lenacapavir on the incremental cost-utility ratio (ICUR, in € per additional QALY), with a price-to-ICUR ratio calculated using the following formula: ICUR = 227.97x - 508,149; where x is the cost of double lenacapavir injection. An analysis assuming that the price of lenacapavir is the same as that of lenacapavir (SUNLENCA) showed a price difference of €386,119 compared to the standard strategy, and for a negligible gain in QALY (0,1 additional QALY).
CONCLUSIONS: The analysis showed that the cost-utility results for lenacapavir-based PrEP were primarily dependent on the assumed price of lenacapavir. PURPOSE-2 reported encouraging efficacy results, although its implementation in France still requires incorporation into national guidelines.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE340
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
Infectious Disease (non-vaccine)