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Editor's Correspondence
July 13, 1998

Cost-effectiveness of Chemoprophylaxis After Occupational Exposure to HIV

Arch Intern Med. 1998;158(13):1469-1472. doi:

In reply

Frothingham raises an important point regarding the potential impact of serious treatment complications on the cost-effectiveness of therapeutic interventions. In our analysis of the cost-effectiveness of the use of postexposure prophylaxis (PEP) for health care workers who have been exposed through their occupations to the human immunodeficiency virus (HIV), we considered 2 cost components: the cost of counseling health care workers exposed to HIV on the use of PEP, and the cost of drugs for those who elect to use PEP.1 Diagnostic and treatment costs associated with adverse effects of the recommended antiretroviral treatment (a 4-week course of zidovudine, lamivudine, and indinavir) were not included in this base case analysis. Most documented complications of the recommended antiretroviral therapy (such as gastrointestinal problems, headaches, nausea, and fatigue) are relatively minor and typically resolve on cessation of therapy, although more serious adverse effects, including hyperbilirubinemia and kidney stones, have also been reported in association with the use of these drugs by patients with HIV. However, the toxic effects of short-course therapies used for persons who do not have HIV have not been well documented. As we noted in our article, the results of our analysis are sensitive to the costs associated with the administration of PEP, including monitoring and treating complications of antiretroviral therapy. If these costs are substantial, then PEP may not be cost-effective.1

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