OBJECTIVES

To assess the budget impact of adding an HIV pre-exposure prophylaxis (PrEP) telemedicine intervention (telePrEP) in Mississippi, a state with one of the highest HIV rates in the US.

METHODS

We developed a Markov model of HIV and PrEP use in Mississippi among two eligible populations: 1) men who have sex with men (MSM) and 2) heterosexually active individuals age ≥16 years with indications for PrEP as per US Centers for Disease Control guidelines. The model utilized 3-month time steps and a 5-year time horizon. Model inputs were parameterized using literature, expert opinion, Federal Supply Schedules, and Centers for Medicare and Medicaid Fee Schedules. Costs were reported from the healthcare payer perspective in 2020 dollars and included standard-of-care PrEP (in-person), telePrEP, laboratory testing, PrEP drug, dispensing fee, HIV care, and antiretroviral therapy (ART). We assumed telePrEP uptake increased from 5% to 13% over 5 years among those eligible, impacting individuals without PrEP and on standard-of-care PrEP equally in the treatment mix. We projected costs of implementing telePrEP in addition to standard-of-care PrEP provision compared to standard-of-care PrEP provision only. We performed one-way sensitivity analyses on key parameters to assess uncertainty.

RESULTS

Implementing telePrEP is projected to increase the number of individuals receiving PrEP by approximately 157 yearly and avert a minimum of 206 HIV cases over 5 years. TelePrEP would increase healthcare payers’ budget by $1.35 million in Year 1, $749,800 in Year 2, and $184,500 in Year 3, then decrease the budget by $383,000 and $990,100 in Years 4 and 5, respectively. One-way sensitivity analyses indicated the overall budget was most sensitive to assumptions about HIV incidence and PrEP initiation among MSM and ART initiation.

CONCLUSIONS

Implementing telePrEP in a US state with high HIV incidence can provide health benefits at a modest increase in healthcare payers’ budget over five years.