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April 14, 1999, Vol 281, No. 14 >

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Letters | April 14, 1999

Postexposure Prophylaxis Following HIV Exposure

James G. Kahn, MD, MPH; Steven D. Pinkerton, PhD; A. David Paltiel, PhD
JAMA. 1999;281(14):1269. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-14-jac90002.
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To the Editor: We believe a critical issue has been overlooked in the article by Dr Lurie and colleagues1 and in other discussions of the cost-effectiveness of PEP after HIV exposure. It is estimated that in certain circumstances (ie, a sporadic high-risk exposure with a known seropositive partner), PEP may cost as little as $135,600 per HIV infection averted—less than the cost of treating HIV disease.1- 3 Under less favorable circumstances, the cost may still be less than $50,000 per life-year gained, a figure that compares favorably with many current uses of patient care resources.4 For decision makers who aim to maximize total benefits conferred by health care spending, these results may be cited to support funding for PEP. We agree with this assessment, provided that the resources for PEP come from medical care budgets, ie, from health insurance.

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