Over the past 30 years, antiretroviral therapy (ART) has transformed HIV into a manageable condition, drastically reducing mortality where access is available. Yet, the disease remains a significant challenge, particularly in low- and middle-income countries. Excitingly, curative therapies (CTx) might be within reach in the next 10-20 years. But addressing challenges related to pricing and financing will be essential for ensuring global access. To address these, we need to understand the economic value of CTx and develop a decision-analytic model to estimate long-term costs, health outcomes, and a value-based price for each country.

Objectives

Our objective was to model the long-term health and cost outcomes of HIV across different countries, evaluate the impact of future CTx on these outcomes, and determine the country-specific value-based prices (VBPs) for CTx.

Methods

We developed a decision-analytic model to assess the long-term economic and health impacts of a hypothetical HIV CTx in combination with existing ART versus ART alone. This model used data from seven low- and middle-income countries and five high-income countries, integrating local ART costs and HIV epidemiology to project outcomes up to the year 2100.

Results

The analysis revealed several key insights:

  • Impact on DALYs: CTx led to fewer disability-adjusted life years (DALYs) compared to ART alone.
  • Cost Savings: Reduced ART and standard care costs, with greater savings in scenarios with more individuals cured.
  • Epidemic Decline: CTx accelerated reductions in HIV cases and AIDS deaths, advancing the decline of the epidemic by decades.
  • Value-Based Price (VBP) Estimates:
  • Variation by Country: VBP ranged widely, with South Africa's VBP from $10,500 to $197,600, and the US from $203,700 to $8.7 million.
  • Factors Influencing VBP: Higher VBPs in countries with greater HIV caseloads and higher incomes; VBP varied based on ART efficacy, CTx rollout, and local ART uptake and costs.
  • Scenario Variability:
  • South Africa: VBP ranged from -13% to +41% of the base case, most affected by HIV transmission rates among early HIV individuals.
  • United States: VBP ranged from -28% to +208%, with HIV prevalence in 2010 being the most significant factor.

Conclusion

Curative therapies for HIV hold the potential for transformative long-term benefits. They could not only improve health outcomes and quality of life for patients but also reduce the economic burden on healthcare systems. The promise of such therapies highlights the importance of continued research and investment in curative strategies.

At Prime, we are driven by a commitment to advancing knowledge and fostering innovation. Our dedication to exploring the full impact of HIV therapies fuels our passion for improving patient lives and shaping the future of HIV treatment.