Exploring the Potential Health Impact and Cost-Effectiveness of AIDS Vaccine within a Comprehensive HIV/AIDS Response in Low- and Middle-Income Countries.

The Investment Framework Enhanced (IFE) proposed in 2013 by the Joint United Nations Programme on HIV/AIDS (UNAIDS) explored how maximizing existing interventions and adding emerging prevention options, including a vaccine, could further reduce new HIV infections and AIDS-related deaths in low- and middle-income countries (LMICs). This article describes additional modeling which looks more closely at the potential health impact and cost-effectiveness of AIDS vaccination in LMICs as part of UNAIDS IFE.An epidemiological model was used to explore the potential impact of AIDS vaccination in LMICs in combination with other interventions through 2070. Assumptions were based on perspectives from research, vaccination and public health experts, as well as observations from other HIV/AIDS interventions and vaccination programs. Sensitivity analyses varied vaccine efficacy, duration of protection, coverage, and cost.If UNAIDS IFE goals were fully achieved, new annual HIV infections in LMICs would decline from 2.0 million in 2014 to 550,000 in 2070. A 70% efficacious vaccine introduced in 2027 with three doses, strong uptake and five years of protection would reduce annual new infections by 44% over the first decade, by 65% the first 25 years and by 78% to 122,000 in 2070. Vaccine impact would be much greater if the assumptions in UNAIDS IFE were not fully achieved. An AIDS vaccine would be cost-effective within a wide range of scenarios.Even a modestly effective vaccine could contribute strongly to a sustainable response to HIV/AIDS and be cost-effective, even with optimistic assumptions about other interventions. Higher efficacy would provide even greater impact and cost-effectiveness, and would support broader access. Vaccine efficacy and cost per regimen are critical in achieving cost-effectiveness, with cost per regimen being particularly critical in low-income countries and at lower efficacy levels

Data from: Exploring the potential health impact and cost-effectiveness of AIDS vaccine within a comprehensive HIV/AIDS response in low- and middle-income countries

Background: The Investment Framework Enhanced (IFE) proposed in 2013 by the Joint United Nations Programme on HIV/AIDS (UNAIDS) explored how maximizing existing interventions and adding emerging prevention options, including a vaccine, could further reduce new HIV infections and AIDS-related deaths in low- and middle-income countries (LMICs). This article describes additional modeling which looks more closely at the potential health impact and cost-effectiveness of AIDS vaccination in LMICs as part of UNAIDS IFE. Methods: An epidemiological model was used to explore the potential impact of AIDS vaccination in LMICs in combination with other interventions through 2070. Assumptions were based on perspectives from research, vaccination and public health experts, as well as observations from other HIV/AIDS interventions and vaccination programs. Sensitivity analyses varied vaccine efficacy, duration of protection, coverage, and cost. Results: If UNAIDS IFE goals were fully achieved, new annual HIV infections in LMICs would decline from 2.0 million in 2014 to 550,000 in 2070. A 70% efficacious vaccine introduced in 2027 with three doses, strong uptake and five years of protection would reduce annual new infections by 44% over the first decade, by 65% the first 25 years and by 78% to 122,000 in 2070. Vaccine impact would be much greater if the assumptions in UNAIDS IFE were not fully achieved. An AIDS vaccine would be cost-effective within a wide range of scenarios. Interpretation: Even a modestly effective vaccine could contribute strongly to a sustainable response to HIV/AIDS and be cost-effective, even with optimistic assumptions about other interventions. Higher efficacy would provide even greater impact and cost-effectiveness, and would support broader access. Vaccine efficacy and cost per regimen are critical in achieving cost-effectiveness, with cost per regimen being particularly critical in low-income countries and at lower efficacy levels

Dataset - Harmon et al 2015

Excel Results file for Harmon et al 2015

Cost per QALY gained (2027–2070) according to vaccine coverage under two cost scenarios in LICs (discounted at 3% per year) when a vaccine is added to <i>Full Scale-up of IFE</i>.

<p>Other vaccine and implementation characteristics (base case) are outlined in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146387#pone.0146387.t001" target="_blank">Table 1</a>. For cost assumptions see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146387#pone.0146387.t002" target="_blank">Table 2</a>.</p

Estimated total costs for an AIDS vaccination program with base-case characteristics in LMICs under different cost-per-regimen scenarios (see Table 2).

<p>Base-case vaccine and implementation characteristics are outlined in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146387#pone.0146387.t001" target="_blank">Table 1</a>.</p

Reduction of new annual HIV infections with PrEP, TasP and vaccination added individually and in combination to the <i>Full Scale-up of IFE</i> between 2015 and 2070.

<p>Vaccine and implementation characteristics are outlined in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146387#pone.0146387.t001" target="_blank">Table 1</a>. Assumptions on PrEP and TasP can be found in Stover et al. 2014 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146387#pone.0146387.ref014" target="_blank">14</a>].</p

Costs for both <i>Full Scale-up of IFE</i> as a whole and the ART component with this scale-up and number of people on antiretroviral treatment both with and without AIDS vaccination (base case-characteristics).

<p>Base-case vaccine and implementation characteristics are outlined in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146387#pone.0146387.t001" target="_blank">Table 1</a>. For base-case cost assumptions see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146387#pone.0146387.t002" target="_blank">Table 2</a>.</p

Reduction of new annual HIV infections under <i>Full Scale-up of IFE</i> according to vaccine efficacy between 2025 and 2070 (vaccine introduced in 2027).

<p>Other vaccine and implementation characteristics are outlined in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146387#pone.0146387.t001" target="_blank">Table 1</a>.</p