Research Summary

Value Analysis: Improving TDF-FTC PrEP Uptake Could Yield Billions in Health System Value for YMSM

Anthony Calabro, MA

Key Highlights

  • In a CEPAC-Adolescent microsimulation analysis of US young men who have sex with men (YMSM), TAF-FTC was projected to provide greater clinical benefit than TDF-FTC but was not cost-effective at current drug prices.
  • Even if a hypothetical study eliminated uncertainty around PrEP adverse events, TDF-FTC remained the strategy with higher net monetary benefit.
  • Improving TDF-FTC uptake among current YMSM on PrEP was projected to yield a 10-year value of implementation of $7.7 billion.
  • Expanding PrEP use to all YMSM with PrEP indications while improving TDF-FTC uptake was projected to yield a 10-year value of implementation of $31.2 billion.

Improving use of generic tenofovir disoproxil fumarate/emtricitabine (TDF-FTC) for HIV preexposure prophylaxis (PrEP) among US young men who have sex with men (YMSM) may yield greater health system value than conducting a study to eliminate uncertainty about PrEP-related adverse events, according to a poster presented at the 2026 Conference on Retroviruses and Opportunistic Infections in Denver, CO.

The analysis examined whether uncertainty about TDF-FTC adverse events among adolescents warrants further study, given that 37% of providers prescribe tenofovir alafenamide/emtricitabine (TAF-FTC) rather than TDF-FTC for YMSM, despite its higher cost. The researchers noted that incomplete bone mineral density recovery has been reported in adolescent men prescribed TDF-FTC for HIV PrEP. In contrast, increased hypertension risk has been reported for TAF-FTC vs TDF-FTC in adults.

Researchers used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Adolescent microsimulation model, along with value-of-information and value-of-implementation frameworks, to compare 2 daily oral HIV PrEP strategies: TDF-FTC and TAF-FTC. The model simulated US YMSM on PrEP, with inputs including pre- and post-study uptake of TDF-FTC and TAF-FTC, PrEP adherence, drug costs, TDF-FTC bone fracture incidence, and TAF-FTC hypertension incidence.

Projected 10-year outcomes included incremental cost-effectiveness ratios, quality-adjusted life-years (QALYs), costs, value of information, and value of implementation. The investigators examined willingness-to-pay thresholds ranging from $50,000 to $500,000 per QALY, with $100,000 per QALY used in the value of implementation analysis. Probabilistic sensitivity analyses varied HIV incidence, fracture incidence, hypertension incidence, and PrEP adherence.

Study Findings

The study results indicated that TAF-FTC was projected to provide greater clinical benefit but at a substantially higher cost than TDF-FTC. The incremental cost-effectiveness ratio for TAF-FTC vs TDF-FTC was $3.2 million per QALY. Even if a study eliminated uncertainties about adverse events, TDF-FTC would still provide a higher net monetary benefit at current drug prices, implying a value of information of zero, according to the researchers.

Improving TDF-FTC uptake among current YMSM on PrEP was projected to yield a 10-year implementation value of $7.7 billion. In probabilistic sensitivity analyses, TDF-FTC remained the optimal strategy, defined as the strategy with higher net monetary benefit. Expanding PrEP use to all YMSM with PrEP indications, along with improving TDF-FTC uptake, was projected to yield a 10-year implementation value of $31.2 billion.

Clinical Implications

According to the study authors, reducing uncertainty related to PrEP adverse events among adolescents would not influence decision-making around the optimal daily oral HIV PrEP strategy for YMSM. Instead, improving TDF-FTC uptake among those currently on PrEP could lead to substantial 10-year savings.

Expert Commentary

“While reducing uncertainty related to PrEP adverse events among adolescents would not influence decision-making around the optimal daily oral PrEP strategy for YMSM, improving TDF-FTC uptake for those currently on PrEP could lead to 10-year savings of $7.7 billion,” the researchers concluded.

Reference
Zarei HR, Flanagan CF, Pei PP, Reddy KP, Neilan AM. Is a study of PrEP adverse events in adolescents needed? Value of information and implementation analyses. Abstract 1006. In: CROI 2026 Abstract E-Book. Conference on Retroviruses and Opportunistic Infections; February 22-25, 2026; Denver, CO.