Potential population health outcomes and expenditures of HIV vaccination strategies in the United States.

Potential population health outcomes and expenditures of HIV vaccination strategies in the United States.

Estimating the potential health benefits and expenditures of a partially effective HIV vaccine is an important consideration in the debate about whether HIV vaccine research should continue. We developed an epidemic model to estimate HIV prevalence, new infections, and the cost-effectiveness of vaccination strategies in the U.S. Vaccines with modest efficacy could prevent 300,000-700,000 HIV infections and save $30 billion in healthcare expenditures over 20 years. Targeted vaccination of high-risk individuals is economically efficient, but difficulty in reaching these groups may mitigate these benefits. Universal vaccination is cost-effective for vaccines with 50% efficacy and price similar to other infectious disease vaccines.

This is the first analysis to estimate quantitatively the potential health and economic outcomes of a targeted or a universal HIV vaccination programme in the USA, where its estimated that 1.3 million new infections will occur over the next 20 years. Under a variety of scenarios and assumptions about vaccine efficacy and epidemic dynamics in the late-stage US epidemic, investment in vaccines results in positive health and economic outcomes, being ‘good value for money’. These models can be further refined, as we learn more about vaccine efficacy by mode of transmission and intensity of HIV exposure, and then applied to low- and middle-income countries where 40 million new infections are expected to occur over the next 20 years.