OBJECTIVES: Today HIV patients on effective antiretroviral therapy (ART) can expect a near normal life expectancy albeit with some toxicity and daily pill burden. This study examines the price potential of a curative HIV treatment in four European healthcare systems.

METHODS: Relevant literature sources and price databases were reviewed to generate hypotheses and identify appropriate ex-manufacturer list price benchmarks. Qualitative semi-structured interviews with EU payers (Germany, UK, France & Italy) were conducted (n=15). Key value drivers for reimbursement were explored by market archetype and a Van Westendorp price sensitivity analysis was used to quantify the willingness to pay as a multiple of the annual cost of ART.

RESULTS: Respondents were highly satisfied with current treatment options and identified daily oral ART as the appropriate comparator. In product attribute analysis ‘Cure rate’ was ranked the most important factor for Health Technology Assessment (HTA). Most payers stated unprompted an expectation that cure rates should be at a similar level to Hepatitis C therapies. Safety and QOL were the second and third most important attributes, respectively. On average, payers offered multiples of between 5-10 times the annual cost of ART for a curative treatment. Lower multiples were offered by ‘clinical value’ payer archetypes (France & Germany) who cited concerns the product may not demonstrate a benefit versus the clinical comparator in HTA. Respondents noted the high disease prevalence and expected this to apply significant downward pressure on pricing. In addition, payers may seek to restrict access or employ annuities-based outcomes payments to reduce risk and spread the cost of therapy over time.

CONCLUSIONS: A curative treatment is expected to face intense payer scrutiny given the excellent standard of care and potential budget impact. However, broad reimbursement may be possible provided the product is cost effective vs ART over a reasonable time frame.