It is important to think about how HIV impacts different communities in contrasting ways, and as such we wanted to think about how PrEP may or may not be more effective in select communities. We know that HIV hits communities of Men that Have Sex with Men (MSM) the hardest. The CDC estimates that 4% of men in the US are MSM and that they contact HIV at a rate that is 44 times more than men who are not MSM. We adjusted our susceptible population to fit this statement of 4% and adjusted the contact rate accordingly. We then ran the model forward and saw that when putting the same number of people on PrEP (500,000) in the MSM community, PrEP is 13x more effective at preventing cases of HIV. This has definite public policy implications as it relates to the way PrEP is distributed and targeted. These results suggest that when addressing HIV in the United States, the government should work to target MSM populations for preventative health services. It is important to keep in mind the unintended consequences of the government targeting already marginalized groups, and as such, it is important to craft this treatment policy in a holistic and conscious way with the support of community leaders.
We sought to investigate the cost effectiveness of PrEP as a treatment method by analyzing how many cases PrEP would prevent and comparing that cost to how much would have to be spent on PrEP. PrEP costs $18,000 a year and a generic release is estimated to drive prices down 80% to around $3,500 . Now, in 2020 the model states 200,000 MSM will be on PrEP to save 600 new cases of HIV. With this data and a lifetime cost of HIV adjusted for 2018 dollars to $433,000 , PrEP needs to cost under $1,000 to be cost effective. Clearly the benefits of PrEP are not restricted to pure cost as it saves individuals and families from the stress of a lifetime burden of HIV. However, this points to government policy implications to work to negotiate down the price of PrEP to save individuals and families while also remaining cost effective. The government should work to further push down the costs of PrEP below $1,000 by 2020.
Looking forward, it would be interesting to investigate the cost effective threshold for PrEP in various other communities that are impacted by HIV. For example, for global policy one could analyze the cost effective threshold in sub-saharan Africa where the contact rate is much higher and the ART treatment rate is lower.