Background Under plausible assumptions, HIV-pre-exposure prophylaxis (HIV-PrEP) is cost-effective for high-risk MSM in England. There is consensus that HIV-PrEP should be delivered via quarterly GUM clinic attendances. BASHH recommends quarterly STI screening for high-risk MSM. An HIV-PrEP policy would have direct (extra consultation time and renal function tests) and indirect (additional STI/HIV screening) GUM clinic resource implications, as well as drug costs.

Aims To explore clinic costs if HIV-PrEP is introduced.

Methods Indirect clinic costs per person per year (PPPY) used the draft 2016/17 National Tariff (£104/follow-up GUM visit). Direct HIV-PrEP-specific clinic costs were estimated by micro-costing. Direct tenofovir/emtricitabine costs used BNF prices (£12/tablet), assuming 50%/50% daily/intermittent dosing. GUMCADv2 provided numbers of eligible MSM and likely additional clinic attendances.

Results MSM, clinically assessed as high-risk, currently attend GUM services twice/year (median); for those given PrEP, two additional attendances would be required annually with indirect costs of £208 PPPY. In year one, the direct cost of starting HIV-PrEP would be £176 PPPY, including an additional month-1 follow-up. Clinical risk-assessment should result in offering HIV-PrEP to 8,000 high-risk MSM annually. There is considerable turnover in this group, with <10% remaining high-risk after two years. Assuming steady increases in coverage (from 2,000 in year one to 5,000 by year four), direct and indirect clinic costs would be £0.8M–£2M/year and drug costs £8M–£20M/year.

Discussion A national HIV-PrEP programme is likely to incur large drug costs but limited clinic costs. A substantially reduced drug price will be needed to enable wide coverage and maximise population impact.