In a related editorial, the authors highlight that whilst costs will be incurred immediately, the health benefits and cost savings will only be realised far into the future (over the duration of the 80 years modelled). This timeframe is typical of many preventive health-care interventions. The study recognises that costs of PrEP are likely to fall as generic formulations become more widely used, and applies conservative assumptions on future prices. The lower the costs of PrEP, the less time it will take for the benefits to outweigh the costs incurred.
These findings therefore call for NHS policy makers to negotiate with manufacturers to get favourable deals on prices and to be far sighted. This approach is currently challenging when unmet needs across all areas of health care are so great and NHS resources are stretched so thinly. However, this study provides the definitive evidence to support such a decision.
Currently, NHS England is conducting a trial, which will see PrEP provided to around 10,000 people over the initial three years, and will gather clinical evidence on optimal targeting, uptake and implementation of PrEP on a large scale. Findings from the trial will inform follow-on routine commissioning