How Much Are We Willing to Pay for Preexposure Prophylaxis in the United States?
Authors: Carlos del Rio, Wendy S. Armstrong
Journal: Annals of Internal Medicine (2020)

Editorials5 May 2020How Much Are We Willing to Pay for Preexposure Prophylaxis in the United States?Carlos del Rio, MD and Wendy S. Armstrong, MDCarlos del Rio, MDEmory University School of Medicine and Grady Health System, Atlanta, Georgia (C.D., W.S.A.)Search for more papers by this author and Wendy S. Armstrong, MDEmory University School of Medicine and Grady Health System, Atlanta, Georgia (C.D., W.S.A.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-0799 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 2012, tenofovir disoproxil fumarate coformulated with emtricitabine (F/TDF [Truvada]) was approved by the U.S. Food and Drug Administration as preexposure prophylaxis (PrEP) for the prevention of HIV infection after licensing studies showed indisputable evidence of effectiveness in men who have sex with men (MSM), men who have sex with women, and heterosexual women. Subsequent experiences in Australia and Great Britain have shown that in addition to widespread treatment for persons with HIV, broad use of PrEP is critical to achieving epidemic control (1, 2). Despite this evidence, scaling up of PrEP use in the United States has been slow, ...References1. Grulich AE, Guy R, Amin J, et al; Expanded PrEP Implementation in Communities New South Wales (EPIC-NSW) Research Group. Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. Lancet HIV. 2018;5:e629-e637. [PMID: 30343026] doi:10.1016/S2352-3018(18)30215-7 CrossrefMedlineGoogle Scholar2. Nwokolo N, Hill A, McOwan A, et al. Rapidly declining HIV infection in MSM in central London. Lancet HIV. 2017;4:e482-e483. [PMID: 29066095] doi:10.1016/S2352-3018(17)30181-9 CrossrefMedlineGoogle Scholar3. Walensky RP, Horn T, McCann NC, et al. Comparative pricing of branded tenofovir alafenamide–emtricitabine relative to generic tenofovir disoproxil fumarate–emtricitabine for HIV preexposure prophylaxis. A cost-effectiveness analysis. Ann Intern Med. 2020;172:583-90. doi:10.7326/M19-3478 LinkGoogle Scholar4. Morne J, Gonzalez CJ; New York State Department of Health. Letter to colleagues and community members about HIV preexposure prophylaxis. October 2019. Accessed at www.health.ny.gov/diseases/aids/general/prep/docs/truvada_fact_letter_2019.pdf on 27 February 2020. Google Scholar5. Health Resources & Services Administration. Ending the HIV Epidemic: A Plan for America. 2020. Accessed at www.hrsa.gov/ending-hiv-epidemic on 27 February 2020. Google Scholar6. IQVIA Institute for Human Data Science. Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023. 9 May 2019. Accessed at www.iqvia.com/insights/the-iqvia-institute/reports/medicine-use-and-spending-in-the-us-a-review-of-2018-and-outlook-to-2023 on 27 February 2020. Google Scholar7. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services; 2019. Accessed at http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf on 27 February 2020. Google Scholar Author, Article, and Disclosure InformationAffiliations: Emory University School of Medicine and Grady Health System, Atlanta, Georgia (C.D., W.S.A.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0799.Corresponding Author: Carlos del Rio, MD, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, FOB Room 201, Atlanta, GA 30303; e-mail, [email protected]edu.Current Author Addresses: Dr. del Rio: Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, FOB Room 201, Atlanta, GA 30303.Dr. Armstrong: Department of Medicine, Emory University School of Medicine, Grady Infectious Diseases Program, 341 Ponce de Leon Avenue, Atlanta, GA 30308.This article was published at Annals.org on 10 March 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparative Pricing of Branded Tenofovir Alafenamide–Emtricitabine Relative to Generic Tenofovir Disoproxil Fumarate–Emtricitabine for HIV Preexposure Prophylaxis Rochelle P. Walensky , Tim Horn , Nicole C. McCann , Kenneth A. Freedberg , and A. David Paltiel Metrics Cited byEvaluating the combination of emtricitabine/ tenofovir alafenamide fumarate to reduce the risk of sexually acquired HIV-1-infection in at-risk adultsEmtricitabine/tenofovir alafenamide not cost effective despite fewer AEsEmtricitabine/tenofovir alafenamide not cost effective despite fewer AEs 5 May 2020Volume 172, Issue 9Page: 623-624KeywordsAIDSDecision makingDrugsHIVHIV preventionMale male sexual contactPreexposure prophylaxisQuality adjusted life yearsRenal failureToxicity ePublished: 10 March 2020 Issue Published: 5 May 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. 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