The Potential Cost-Effectiveness of HIV Vaccines: A Systematic Review

OBJECTIVE: The aim of this paper was to review and compare HIV vaccine cost-effectiveness analyses and describe the effects of uncertainty in model, methodology, and parameterization. METHODS: We systematically searched MEDLINE (1985 through May 2016), EMBASE, the Tufts Cost-Effectiveness Analysis (CEA) Registry, and the reference lists of articles following Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligibility criteria included peer-reviewed manuscripts with economic models estimating the cost-effectiveness of preventive HIV vaccines. Two reviewers independently assessed study quality and extracted data on model assumptions, characteristics, input parameters, and outcomes. RESULTS: The search yielded 71 studies, 11 of which met the inclusion criteria. Populations included low-income (n = 7), middle-income (n = 4), and high-income countries (n = 2). Model structure varied, including decision tree (n = 1), Markov (n = 5), compartmental (n = 4), and microsimulation (n = 1). Most studies measured outcomes in quality-adjusted life-years (QALYs) gained (n = 6), whereas others used unadjusted (n = 3) or disability-adjusted life-years (n = 2). The range of HIV vaccine costs were $US1.54–75 in low-income countries, $US55–100 in middle-income countries, and $US500–1000 in the USA. Base-case incremental cost-effectiveness ratios (ICERs) ranged from dominant (cost offsetting) to $US91,000 per QALY gained. CONCLUSION: Most models predicted HIV vaccines would be cost-effective. Model assumptions about vaccine price, HIV treatment costs, epidemic context, and willingness to pay influenced results more consistently than did assumptions on HIV transmission dynamics. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s41669-016-0009-9) contains supplementary material, which is available to authorized users.